Posted By J Knight
Hi Folks,

We have a care worker with dermatitis on her feet, caused by assisting people in the shower. Now, the probable cause is water, and this is not listed in the schedule to RIDDOR as a reportable cause for work-related dermatitis. However, the schedule does have a catch-all of 'any other known irritant ect'. Now, my question is, is water a 'known irritant' in the meaning of the schedule? I suspect it isn't, but any advice as usual will be happily received,

John

Posted By J Knight
That's an interesting question Daren; the IP is in Aberdeen, and I am in East Yorkshire, so the first trivial answer has to be 'by remote control'. The management at the Care Centre has suggested flip-flops, though I fail to see how that will work. A previous employer offered wellies to Care Staff assisting with showering, and these were quite popular.

It is unusual, this is the first case I've heard about in 10 years of H&S in the care sector, but there is no dubt we have to do something. If anybody has any other bright ideas for appropriate controls I would be delighted to hear them,

John.

Posted By Steven
What about verucca socks?

http://www.newitts.com/p...90/Anti_Verruca_Sock.htm

Just a thought!?

Steve

Posted By J Knight
The verucca socks sound good, but I would have concerns about latex allergy; I am aware that according to good authorities there should be no problem with low surface protein non powdered latex but unfortunately CSCI and the Scottish Care Commission dopn't see it that way. Wind surfing boots sound good, and I suppose there's the sealskinz type of waterproof outdoor sock with a membrane,

John

Posted By J Knight
Hi CRT,

This is a good question; management at the Care Centre are fairly clear that this is occupational dermatitis, so I will go with their judgment,

John

Posted By CRT
John,
not disputing the diagnosis (though agree to get confirmed by GP)i`m just interested to know how the managers can say that it is caused by her present work activity, have they established her previous employment history, has she sufferd from skin conditions in the past, does she take part in any activities outside of work that bring her into contact with sensitising materials. I feel that it is too easy to say that a work activity is the direct cause of ill-health. How many people know of someone claiming an occupational injury or ill health when it was caused by recreational activities. A good occupational health practitioner should investigate all aspects of a persons work and social activities to determine the source of exposure, however (finally) i would agree that its sensible to take steps to reduce immersion time and/or skin contact until you are sure.

Regards

Colin

Posted By Chris Packham
Firstly, Paul is correct. For a skin problem to be reportable under RIDDOR you need a diagnosis of occupational skin disease by a registered medical practitioner. Note that time off does not enter the equation, it is the diagnosis that is the trigger.

However, in my work I frequently encounter situations where such a diagnosis has been made but where a proper, structured investigation reveals that the skin problem was anything other than occupational or where the occupational element was actually very small.

The most common form of occupational skin disease is irritant contact dermatitis. This is NEVER to a single chemical but is chronic (i.e. builds over time) due to repeated contact between that part of the skin and many different chemicals.

Having said this, water is a recognised skin irritant and one of the most common causes of occupational contact dermatitis. Wet work is notorious for causing irritant damage to the skin, as is the long term wearing of gloves. It may be of interest that in Germany where exposure to water or wearing of gloves is for more than 2 hours in an eight hour shift, this classifies as a hazardous situation and a special regulation applies (TRGS401).

The first action in any investigation is to determine whether you are dealing with irritant or allergic contact dermatitis. Only a qualified dermatologist experienced in contact dermatitis can provide you with the appropriate diagnosis. GPs rarely have either the training or experience to do this. Unfortunately, it isn't that simple either, as you can have a combination of both irritant and allergic reactions and I challenge any dermatologist to tell you what role each of these reactions is playing.

This is a horrendously complex aspect of occupational health and safety and one where it is all too easy to make assumptions and take action that appears logical but that, in reality, is making the situation worse. I have lost count of the number of times that I have investigated a suspected case of occupational skin disease to find that what the company has done has actually contributed to the problem.

If you want to know more feel free to contact me direct (01386 832 311)

Chris Packham

Posted By J Knight
Hi Folks,

Thanks as always for the very helpful responses, Chris in particular but every body else as well. HSE want it reportng just on a GP diagnosis, so we will, but we will get some further opinion before we determine our final actions. It seems that the affected person is showering service users and assisting at the hydrotherapy pool, so has wet feet for prolonged periods; of course the chlorine could be a factor.

Once again, thanks,

John

Posted By J Knight
Hi Saracen,

I do agree, but I can't see any alternative in this case; we are reasonably sure already about the diagnosis, and we do have to act to ameliorate the condition. We will keep our service users informed and hope to take the least visually intrusive remedy available,

John

Posted By J Knight
Hi John,

Not quite right as it happens ;-). The worker is just assisting somebody in the shower, perhaps by passing the soap, or maybe by scrubbing under the armpits etc; the service users will be either standing or sitting in a shower chair. The worker is wearing an apron to keep her clothes dry (she isn't directly under the shower, but off to one side) but her feet get wet because of the inevitable splashing, and the design of the bathroom. The problem arises from having wet feet, which since they are in wet shoes don't get a chance to dry adequately,

John

Posted By J Knight
Hi Folks,

The news so far is that I've been up to Scotland to have a chat with the managers and discuss solutions.

First of all, I have to thank people who raised questions about the diagnosis; we do intend to ask the IP to have further examination by a specialist, and as a first step have contacted the local NHS with that in mind. After all, if water is not the problem or only part of the problem we still have a worker with dermatitis, and although it is responding to topical steroids this isn't an ideal solution. I do accept that it might not even be work related, but the evidence we have at the moment indicates that it is and we are initially treating it as such.

And thanks also to everybody who has suggested solutions. We have decided to get some oversize wellies which people can wear over their shoes. We don't think as yet that we need to ensure that the top of the boot is sealed, as the wetting is caused largely by low level splashing, rather than by the direct action of the shower. This is also a relatively cheap option, and we will review it shortly after inception; as it's cheap if it isn't working we can abandon it and go for a more expensive solution such as windsurfing boots etc.

And the people who use our service will not have a problem with staff in wellies, indeed their reaction so far to the idea is amusement rather than anything else,

John

Posted By Saracen11
Hi J Knight, more of an after-thought really... would there be any merit in installing a screen around the bottom of the shower? The type I have in mind is similar to one a person in a wheelchair might use after entering the cubile, to close around themselves (imagine a toughened glass folding shower screen, cut in half and used in the same way).

Here's hoping you know what I mean?

Good luck with this.

Kind regards

Posted By Bill Elliott
John - noted the reference to assisting in the hyrotherapy pool - the HSE and HPA produced a document "Management of Spa Pools - Controlling the risk of infection" which may offer you you some assistance. It is available from the HPA web site as a download. Then again I may be way off beam. Regards