key: cord-0818654-hl8zmfxs authors: Erdem, Yasemin; Inal, Sena; Sivaz, Onur; Copur, Sevkiye; Boluk, Kubra N.; Ugurer, Ece; Kaya, Hazel E.; Gulsunay, Ilayda E.; Sekerlisoy, Gul; Vural, Osman; Altunay, Ilknur K.; Aksu Çerman, Aslı; Özkaya, Esen title: How does working in pandemic units affect the risk of occupational hand eczema in healthcare workers during the coronavirus disease‐2019 (COVID‐19) pandemic: A comparative analysis with nonpandemic units date: 2021-04-18 journal: Contact Dermatitis DOI: 10.1111/cod.13853 sha: 8a7709e3ad99c9ff0452668c341f606d5f0e778a doc_id: 818654 cord_uid: hl8zmfxs BACKGROUND: Hand eczema (HE) has increased among healthcare workers (HCWs) working in coronavirus disease‐2019 (COVID‐19) units, and was associated with increased hand hygiene practices. OBJECTIVES: To compare the prevalence and clinical characteristics of HE, and hand hygiene practices in HCWs working in COVID‐19 and non‐COVID‐19 units. METHODS: A total of 244 HCWs working in COVID‐19 (n = 118) and non‐COVID‐19 patient care units (n = 126) were examined by dermatologists with regard to demographic parameters and hand hygiene practices. The COVID‐19 and non‐COVID‐19 groups were matched at a 1:1 ratio according to age, atopy, and generalized dry skin. RESULTS: HE was more frequent in the COVID‐19 group (48.3% vs 12.7%, P < .001), whereas working years (P < .05) and additional housework at home (P < .001) were longer in the non‐COVID‐19 group. After the development of HE, moisturizing creams were reported to be more frequently used in the COVID group (P < .001). Topical corticosteroids were used in a minority (40% in the COVID group and 26.7% in the non‐COVID group). CONCLUSIONS: HCWs in COVID‐19 units developed HE more frequently. A majority increased the frequency of moisturizer use, instead of using topical corticosteroids, after the development of HE for the purpose of treating eczema. New approaches are needed for the prevention and management of HE in HCWs, especially by facilitating access to dermatologists. that has spread rapidly worldwide and was eventually declared a pandemic. Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is mainly disseminated via respiratory droplets, contact transmission from infected surfaces and objects is also known to play a role in the human-to-human transfer of the virus. 1 Because hand hygiene is one of the most important methods to prevent contact transmission of SARS-CoV-2, the World Health Organization (WHO) recommended hand hygiene practices by using alcohol-based hand rubs and/or handwashing with water and soap. 1 The risk of occupational hand eczema (HE) has increased in healthcare workers (HCWs), due to infection control methods including frequent hand hygiene practices (handwashing and using disinfectants) and wearing protective gloves. [2] [3] [4] [5] The prevalence of HE was reported to be between 12% and 65% depending on different methods applied during the nonpandemic era. [2] [3] [4] [5] Personal atopy, familial atopy, and handwashing more than 20 times per day have been suggested as independent risk factors for the development of HE in HCWs. [2] [3] [4] The frequency of additional handwashing and the use of disinfectants have increased among HCWs during the pandemic when compared with the non-pandemic era and these were related to the increase in the number of patients with HE. [6] [7] [8] [9] Lan et al 6 reported that about 70.4% of HCWs in COVID-19 units had hand skin damage. However, the frequency of hand hygiene practices and HE was found to increase among HCWs in non-COVID-19 units as well. 7 We have previously showed that HE was diagnosed in 50.5% of HCWs in COVID-19 units. 8 In this study, we aimed to compare the prevalence and the clinical characteristics of HE as well as hand hygiene practices in HCWs working in COVID-19 and non-COVID- 19 units. According to whether the participants were working in COVID-19 or non-COVID-19 units, they were divided into two groups: COVID and non-COVID. First, the demographic and hand hygiene practice parameters were compared between the two groups (Tables 1 and 2) . Then, the COVID and non-COVID groups were matched at a 1:1 ratio according to age (within a range of ±5 years), his- The descriptive statistics of the evaluated parameters were presented as the mean, standard deviation, minimum and maximum values, and median scores for the numerical variables and as numbers and percentages for the categorical variables. The comparative analyses were The cohort included 244 HCWs (153 females and 91 males). The mean age of the cohort was 30.6 (standard deviation 7.3) years. The demographic and clinical parameters, as well as the hand hygiene practices at work and at home are summarized in Tables 1 and 2 . HE was significantly more frequent (P < .001) in the COVID group. The mean age of individuals (P < .05), working years (P < .001), weekly work hours (P < .05), and additional housework at home (P < .001) were significantly higher in the non-COVID group. HCWs in the COVID group were more frequently working in inpatient clinics, whereas those in the non-COVID group were more frequently working in the emergency units. AD/atopic skin was significantly more frequent in the COVID group (P < .05). The number of patients who never use moisturizing creams after handwashing at work was higher in the non-COVID group (P < .001). Handwashing at home five to ten times a day was more common in the non-COVID group, whereas 11 to 20 times a day was more frequent in the COVID group (P < .05). T A B L E 3 The description and the comparison of demographical parameters of COVID and non-COVID groups in matched-pair analysis a A matched-pair analysis to exclude personal risk factors confirmed the significantly higher share of HE in the COVID group (P < .001). Similar to the overall cohort, working years (P < .05), additional housework at home (P < .001), and the number of patients who never use moisturizing creams after handwashing at work were higher in the non-COVID group (P < .001). In addition, the matched-pair analysis showed that working in intensive care unit was higher in the non-COVID group (Tables 3 and 4 ). The clinical features of the participants with HE are detailed in Table 5 . Irritant contact dermatitis and erythema-squamous morphology were the most common clinical features in both groups. The median HECSI score was 24 (range 3-84) in the COVID group, and 3 (range 1-32) in the non-COVID group. HE was severe in 36.8% and 6.25% of the COVID and non-COVID groups, respectively (Fisher exact test, P < .05; odds ratio 6.5, 95% CI 0.9-46.1). In particular, HE was mild in 75% of the participants in the non-COVID group. interestingly, in that study, the self-reported HE was only 14.9%, without a significant difference between the two groups. Handwashing more than 20 times/shift, having water exposure for more than 2 hours/shift, and occlusive glove use for more than 2 hours/shift were defined as "wet work," and were reported as the most important environmental irritant factors increasing the risk of HE. 17, 18 Handwashing frequency over 20 times daily was described as an independent risk factor for the development of HE in HCWs. 4, 14 However, these irritant factors were not identified as independent risk factors for HE in this study. Hamnerius et al 2 reported a dosedependent association between handwashing with water-soap and HE. It might be assumed that the handwashing frequency of HCWs 13, 14 Interestingly, HCWs in the non-COVID group in this study had a higher share of working years and additional housework, the latter probably due to the prohibition of HCWs in the COVID group from doing housework due to social isolation from other family members at home. Additional wet work at home might be regarded as an additional irritant factor due to increased exposure to water/soap. Lan et al 20 showed that there was a positive correlation between the risk of HE in HCWs and the duration of work. Indeed, the longer duration of work and additional housework were more frequently associated with the development of HE in the non-COVID group, although this was not statistically significant. As a striking finding, the frequency of moisturizer use after handwashing was higher in individuals with HE in this study. The use of moisturizer is one of the most important skincare precautions recommended to prevent the development of HE. Moisturizers provide a protection against HE by supporting the regeneration of epidermal barrier. 21 28 Moreover, regular use of moisturizers after handwashing and before wearing gloves was underlined. 25 A lipid-rich moisturizer should be used at night; then, cotton gloves or loose plastic gloves should be worn to create an occlusive barrier. 25 All products which come into contact with hands (eg, soap, moisturizer, disinfectants) should be fragrance and preservative free. [26] [27] [28] In addition to these, it was recommended that patients with severe and persistent HE should be evaluated by the dermatologists. [25] [26] [27] It is utmost important for HCWs to follow these recommendations as there is an increased exposure to skin-irritating factors such as frequent handwashing and use of disinfectants and gloves owing to the pandemic conditions. However, a considerable number of HCWs in this study did not comply with these recommendations, considering that almost one-third of HCWs in the COVID group and three-fourth of HCWs in the non-COVID group never used moisturizing hand creams after handwashing in the hospital. The main limitation of this study was that the number of the participants was not high; however, it might be adequate when considering the special pandemic conditions. The main strength of this study was that all participants were evaluated by face-to-face examinations by dermatologists. Our study showed that the risk of HE was significantly increased in HCWs working in COVID-19 units, when compared with those in non-COVID-19 units. The most striking finding was that HCWs who were unable to contact a dermatologist continued to use a moisturizer for the purpose of treating their HE. The frequency of moisturizer use was higher in those with severe HE. There is need for a better approach to the prevention and management of HE in HCWs during the pandemic conditions, especially by facilitating access to the dermatologists. There are no conflicts of interest. Yasemin Erdem: Conceptualization; data curation investigation; methodology; resources; software; writing-original draft; writing-review & editing. Sena Inal: Data curation; investigation Onur Sivaz: Data curation; investigation; software. Sevkiye Copur: Data curation; investigation; software. Kubra Boluk: Data curation; investigation; software. Ece Ugurer: Data curation; investigation; software. Hazel Kaya: Data curation Gul Sekerlisoy: Data curation; investigation; software. Osman Vural: Data curation; investigation; software. Ilknur Altunay: Data curation; investigation; methodology. Aslı Aksu Çerman: Data curation; investigation; methodology. 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How does working in pandemic units affect the risk of occupational hand eczema in healthcare workers during the coronavirus disease-2019 (COVID-19) pandemic: A comparative analysis with nonpandemic units https://orcid.org/0000-0003-3979-7486Esen Özkaya https://orcid.org/0000-0002-9585-9509