Why focus on work-related contact dermatitis?
Work-related contact dermatitis accounts for a significant proportion of work-related ill health and therefore a specific Skin Disease National Project has been set up to address this.
The aim of the Skin Disease Project is to achieve a 10% reduction in the incidence of dermatitis by 2008 when compared with the incidence in 2004. The 2004/5 Self-Reported Work-Related illness survey estimated the prevalence of self-reported work-related skin disease in Great Britain as 29,000. However, the true figure is likely to be higher than this. For example a study of British hairdressers estimated that over 45% (approx 50,000) suffer from dermatitis.
What is Dermatitis?
Dermatitis is an inflammatory condition of the skin. It can vary in severity. Dermatitis is not infectious, so it cannot be passed from one person to another.
Typical signs of dermatitis are:- dryness, itching, redness, swelling, blistering, cracking, flaking and bleeding. In severe cases nails can also be affected. Work-related dermatitis is caused or made worse by work. It can develop as a consequence of workplace exposure to physical, chemical (including 'wet work') or biological agents or to mechanical forces.
This project is only concerned with dermatitis caused by hazardous chemical agents, including 'wet work' (by which we mean work that involves hands being wet for significant periods during the working day; as a guide - more than two hours a day or twenty to forty hand washes a day). Wet work is of particular concern when in combination with exposure to soaps, detergents or solvents as the skin is eventually stripped of its natural protection.
The most commonly affected part of the body is the hands. Hand dermatitis accounts for almost 75% of all dermatitis. This is because hands are often used as tools, without suitable precautions, allowing exposure of the skin to hazardous agents.
How does exposure happen?
A causative agent may come into contact with the skin in the following ways:-
- Immersing - hands in chemicals and water (e.g. washing or shampooing hair with bare hands)
- Direct handling - of contaminated workplaces or cloths soaked in cleaning chemicals
- Touching contaminated surfaces - such as work benches, tools, clothing & containers
- Splashing - when liquid or powdery chemicals are mixed or handled
Safe working distances
As indicated earlier, hands are the most commonly affected area, because they are frequently used as a handling 'tool' when an alternative handling procedure would eliminate the hazardous exposure. However, clearly some tasks require the use of hands.
When hands are in direct contact with hazardous agents or subjected to 'wet work', employers should ask themselves why an alternative procedure can not be used (e.g. use of a cleaning tool rather than a cloth). South Holland District Council are promoting the use of a 'safe working distance' when handling hazardous agents, and the highlighting the benefits that can be achieved by adopting this approach. Where direct use of hands or contact cannot be avoided, adequate exposure control can be achieved by using a suitable pair of gloves.
How to identify hazardous agents
In terms of dermatitis, chemicals fall into two categories: irritant and skin sensitizing chemicals. The containers of hazardous chemicals and products must carry labels. Key words relevant to health, including dermatitis, are corrosive, irritant, harmful, toxic or very toxic. Employers must be aware of the labels and have evidence to show that they are using this information for risk control.
Chemicals or chemical products labelled with the following R-phrases would indicate that they have the potential to cause dermatitis. Employers should know which, if any, of the R-Phrase(s) is applicable to the product in use and they must apply that information for risk control decisions.
R38 - irritating to the skin
R43 - may cause sensitization by skin contact
R66 - repeated exposure may cause skin dryness or cracking
Chemicals or chemical products with the following hazard phrases have the potential to cause dermatitis at low concentrations. In other words, exposure of the skin to the concentrated chemical or product would cause chemical 'burns', but a diluted concentration (working solution) may have the potential to cause dermatitis. Employers should be aware of this potential and take action to minimize the risk.
R34 - causes burns
R35 - causes severe burns
However, the absence of a label does not necessarily mean that a substance is 'safe' in terms of its potential to cause dermatitis, and employers should recognize this.
Health surveillance will be a new concept for a lot of businesses. It is a very useful tool for early detection and prevention of dermatitis. Early signs can include dry skin, redness, cracking, flaking and blisters. Employers should be aware that health surveillance is not a substitute for the required control measures but it is part of the risk management package.
Employers are required to arrange for suitable health surveillance under Regulation 11 of the Control of Substances Hazardous to Health Regulations, where:-
- there is exposure to 'wet work' and/or substances known to cause dermatitis and
- there is a reasonable likelihood that the working procedures in place would lead to dermatitis.
To meet the requirements of the Control of Substances Hazardous to Health Approved Code of Practice, as a minimum, employers need to appoint and train a 'responsible person' to look actively for signs of dermatitis. A 'responsible person' is someone appointed by the employer, is competent to carry out the relevant procedure, and is charged with reporting to the employer the findings of the procedure. This person may be a supervisor, foreman, first-aider, the employer or themselves
Where there is a risk of dermatitis, the responsible person is expected to:
- carry out skin condition assessment prior to someone joining the company or as soon as possible after an employee has started the work
- carry out periodic checking of the hands and forearms of employees for early signs of dermatitis
- keep records of the skin checks
- inform the employer of the outcomes of the skin checks so that he or she can take necessary action
- if there is an outbreak of dermatitis, advise the employer to seek expert help for managing this and for restoring adequate control of exposure.
The responsible person may carry out skin inspection by direct observation of the skin, using a questionnaire or some other method within his/her competence.
To assist you download our checklists for Hairdressers or Florist to assess the risks to your employees:
Managing sickness absence
Employers need to tell their employees that:
- it is their policy to help employees return to work following sickness absence
- they have a duty to know the cause of employees' sickness, in case it is work-related. If it is, there is a duty to review the systems in place to prevent the illness happening again.
Additional information sources are listed in HSE's Skin at Work website
or contact South Holland District Council, Safety & Environment Team, 01775 761161.
You can also download booklets and posters to display at your workplace: