TY - JOUR
T1 - A behaviour change package to prevent hand dermatitis in nurses working in health care
T2 - the SCIN cluster RCT
AU - Madan, Ira
AU - Parsons, Vaughan
AU - Ntani, Georgia
AU - Wright, Alison
AU - English, John
AU - Coggon, David
AU - McCrone, Paul Richard
AU - Smedley, Julia
AU - Rushton, Lesley
AU - Murphy, Caroline
AU - Cookson, Barry
AU - Lavender, Tina
AU - Williams, Hywel C.
PY - 2019/10/18
Y1 - 2019/10/18
N2 - Background: Although strategies have been developed to minimise the risk of occupational hand dermatitis in nurses, their clinical effectiveness and cost-effectiveness remain unclear. Objectives: The Skin Care Intervention in Nurses trial tested the hypothesis that a behaviour change package intervention, coupled with provision of hand moisturisers, could reduce the point prevalence of hand dermatitis when compared with standard care among nurses working in the NHS. The secondary aim was to assess the impact of the intervention on participants’ beliefs and behaviour regarding hand care, and the cost-effectiveness of the intervention in comparison with normal care. Design: Cluster randomised controlled trial. Setting: Thirty-five NHS hospital trusts/health boards/universities. Participants: First-year student nurses with a history of atopic tendency, and full-time intensive care unit nurses. Intervention: Sites were randomly allocated to be ‘intervention plus’ or ‘intervention light’. Participants at ‘intervention plus’ sites received access to a bespoke online behaviour change package intervention, coupled with personal supplies of moisturising cream (student nurses) and optimal availability of moisturising cream (intensive care unit nurses). Nurses at ‘intervention light’ sites received usual care, including a dermatitis prevention leaflet. Main outcome measure: The difference between intervention plus and intervention light sites in the change of point prevalence of visible hand dermatitis was measured from images taken at baseline and at follow-up. Randomisation: Fourteen sites were randomised to the intervention plus arm, and 21 sites were randomised to the intervention light arm. Blinding: The participants, trial statistician, methodologist and the dermatologists interpreting the hand photographs were blinded to intervention assignment. Numbers analysed: An intention-to-treat analysis was conducted on data from 845 student nurses and 1111 intensive care unit nurses. Results: The intention-to-treat analysis showed no evidence that the risk of developing dermatitis was greater in the intervention light group than in the intervention plus group (student nurses: odds ratio 1.25, 95% confidence interval 0.59 to 2.69; intensive care unit nurses: odds ratio 1.41, 95% confidence interval 0.81 to 2.44). Both groups had high levels of baseline beliefs about the benefits of using hand moisturisers before, during and after work. The frequency of use of hand moisturisers before, during and after shifts was significantly higher in the intensive care unit nurses in the intervention plus arm at follow-up than in the comparator group nurses. For student nurses, the intervention plus group mean costs were £2 lower than those for the comparator and 0.00002 more quality-adjusted life-years were gained. For intensive care unit nurses, costs were £4 higher and 0.0016 fewer quality-adjusted life-years were gained. Harms: No adverse events were reported. Limitations: Only 44.5% of participants in the intervention plus arm accessed the behaviour change package. Conclusion: The intervention did not result in a statistically significant decrease in the prevalence of hand dermatitis in the intervention plus group.
AB - Background: Although strategies have been developed to minimise the risk of occupational hand dermatitis in nurses, their clinical effectiveness and cost-effectiveness remain unclear. Objectives: The Skin Care Intervention in Nurses trial tested the hypothesis that a behaviour change package intervention, coupled with provision of hand moisturisers, could reduce the point prevalence of hand dermatitis when compared with standard care among nurses working in the NHS. The secondary aim was to assess the impact of the intervention on participants’ beliefs and behaviour regarding hand care, and the cost-effectiveness of the intervention in comparison with normal care. Design: Cluster randomised controlled trial. Setting: Thirty-five NHS hospital trusts/health boards/universities. Participants: First-year student nurses with a history of atopic tendency, and full-time intensive care unit nurses. Intervention: Sites were randomly allocated to be ‘intervention plus’ or ‘intervention light’. Participants at ‘intervention plus’ sites received access to a bespoke online behaviour change package intervention, coupled with personal supplies of moisturising cream (student nurses) and optimal availability of moisturising cream (intensive care unit nurses). Nurses at ‘intervention light’ sites received usual care, including a dermatitis prevention leaflet. Main outcome measure: The difference between intervention plus and intervention light sites in the change of point prevalence of visible hand dermatitis was measured from images taken at baseline and at follow-up. Randomisation: Fourteen sites were randomised to the intervention plus arm, and 21 sites were randomised to the intervention light arm. Blinding: The participants, trial statistician, methodologist and the dermatologists interpreting the hand photographs were blinded to intervention assignment. Numbers analysed: An intention-to-treat analysis was conducted on data from 845 student nurses and 1111 intensive care unit nurses. Results: The intention-to-treat analysis showed no evidence that the risk of developing dermatitis was greater in the intervention light group than in the intervention plus group (student nurses: odds ratio 1.25, 95% confidence interval 0.59 to 2.69; intensive care unit nurses: odds ratio 1.41, 95% confidence interval 0.81 to 2.44). Both groups had high levels of baseline beliefs about the benefits of using hand moisturisers before, during and after work. The frequency of use of hand moisturisers before, during and after shifts was significantly higher in the intensive care unit nurses in the intervention plus arm at follow-up than in the comparator group nurses. For student nurses, the intervention plus group mean costs were £2 lower than those for the comparator and 0.00002 more quality-adjusted life-years were gained. For intensive care unit nurses, costs were £4 higher and 0.0016 fewer quality-adjusted life-years were gained. Harms: No adverse events were reported. Limitations: Only 44.5% of participants in the intervention plus arm accessed the behaviour change package. Conclusion: The intervention did not result in a statistically significant decrease in the prevalence of hand dermatitis in the intervention plus group.
KW - DERMATITIS
KW - NURSES
KW - OCCUPATIONAL DERMATITIS
KW - PREVALENCE
KW - RISK
KW - SKIN CARE
UR - http://www.scopus.com/inward/record.url?scp=85073655550&partnerID=8YFLogxK
U2 - 10.3310/hta23580
DO - 10.3310/hta23580
M3 - Article
C2 - 31635689
AN - SCOPUS:85073655550
SN - 1366-5278
VL - 23
SP - 1
EP - 91
JO - Health technology assessment (Winchester, England)
JF - Health technology assessment (Winchester, England)
IS - 58
ER -
