The SCIN (Skin care intervention in nurses) Trial:A Cluster Randomised Trial

Dr I. Madan (Guy’s & St Thomas’ NHS Foundation Trust), Dr V. Parsons (King’s College London), Prof B. Cookson (Royal Free Hampstead NHS Trust), Dr J. English (Nottingham University Hospitals NHS Trust), Prof Dame T. Lavender (University of Manchester), Prof P. McCrone (King’s College

London), Ms C. Murphy (King’s College London), Ms G. Ntani (University of Southampton), Dr L. Rushton, (Imperial College London), Dr J. Smedley (University Hospital Southampton NHS Foundation Trust, Prof H. Williams (University of Nottingham),

Dr A. Wright (King’s College London), Prof D.Coggon (University of Southampton)

METHODS

• The high prevalence of hand dermatitis in nurses is attributed to frequent hand washing with soap and infrequent use of hand moisturisers.

• Occupational irritant hand dermatitis is a major risk in healthcare with a 1-year prevalence estimated to be 24%, compared with less than 10% in the general population.

• The cost to the NHS of its workforce developing hand dermatitis is estimated to be £125 million/year.

• Once an individual has developed irritant hand dermatitis the prognosis is poor.

Recruitment (Study groups)1. Student nurses who were about to start their first clinical placements and who are at increased risk of hand dermatitis because of a past history of atopic disease or handdermatitis (n=40> / site).2. Intensive care nurses working who are at increased risk of hand dermatitis because of the nature of their work (n=40> / site)

Participating sites: 35 Trusts / Health Boards / Universities Randomisation:A. Intervention Plus sites: Access to the web- based Behavioural change programme (BCP). BCP provides information on: when and when not to use: gloves; antibacterialhand gels; and moisturising cream and reminders to contact the occupational health department early if hand dermatitis occurs. Participants invited to form implementation intentions for performing each behaviour in their workplace. Personal supplies of moisturising cream (for student nurses) and provision of optimal equipment for washingand moisturising hands on the wards (for intensive care nurses).

B. Intervention Light sites: Provision of Occupational aspects of management of Dermatitis Leaflet- produced by the Royal College of Physicians. (Note: leaflet alsoprovided to participants in Intervention Plus arm)

Data Collection: 1. Questionnaires: Baseline (At recruitment); Intermediate (Two weeks after BCP offered); Final (At 12 months)2. Ascertainment of hand dermatitis and descriptions of the photographic method: Assessment by dermatologists using an assessment scale of the presence of handdermatitis from photographic images of participants’ hands/wrists. 3. Ward-based audit: Monitoring the availability and usage of hand moisturising cream on intensive care units (intensive care nurses only).4. Additional supplies of personal moisturising cream: Monitoring requests for additional supplies of personal moisturising cream (student nurses only)

Statistical Analysis: Multi-level regression modelling to allow for clustering by site, and will take account of the paired nature of before and after comparisons in individuals.

Primary Outcome: Difference between intervention and control sites in the change in point prevalence of visible hand dermatitis from baseline to 12 months after the intervention.

ACKNOWLEDGEMENT / DISCLAIMER

Funded by the National Institute for Health Research Health Technology Assessment (HTA) Programme 11/94/01. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health.

FLOWCHART: KEY ACTIVITIES

BACKGROUND

• To test the hypothesis that a bespoke, web-based behavioural change programme (BCP) coupled with provision of hand moisturisers, can produce a

clinically useful reduction in the prevalence of hand dermatitis after one year, when compared to standard care in at-risk nurses working the National Health Service (NHS).

• Secondary aims will be to assess impacts on participants’ beliefs and behaviour regarding hand care. In addition, we will assess the cost-effectiveness of the intervention in comparison with normal care.

AIM

ACTIVITIES: 1. Recruit participants (student nurses / ICU nurses) 2. Photograph participants hands/wrists3. Administer Questionnaire A and Self Assessment Dermatitis questionnaire for completion4. Provide participants with oral information on reporting symptoms of hand dermatitis to Occupational Health and provide Dermatitis: Occupational aspects of management leaflet

ACTIVITIY: Randomisation of sites into Intervention PLUS or Intervention LIGHT

INTERVENTION PLUSACTIVITIES: • Email participants link to the web-based behavioural change programme (BCP) and provide ongoing reminders (via mandatory hand hygiene training, ICU matron, posters, and email correspondence) to access the programme Provide student nurses with personal supplies of E45 cream Undertake 4-6 weekly ward-based audits of the availability of moisturising cream products on intensive care units Promote optimisation of equipment for hand cleansing and dispensation for hand moisturising Remind participants to attend Occupational Health department if they develop symptoms of hand dermatitis

INTERVENTION LIGHTACTIVITIES: • Email reminders to participants to attend Occupational Health department if they develop symptoms of hand dermatitis

ACTIVITY: • Invite participants to complete Questionnaire B (two weeks after BCP is offered)

ACTIVITY •Invite ALL participants to have follow up hands/wrists photographed and administer Questionnaire C and Self Assessment Dermatitis question for completion

www.scintrial.org