Nordin, Rusli and Abdullah, Hasniza and Choudary, Sahel Reza and Nouri, Nazmi Mohd and Winn, Than and Sadiq, Ayub
(2003)
Study of contact dermatitis among Hospital cleaners in Kota Bharu, Kelantan.
Study of contact dermatitis among Hospital cleaners in Kota Bharu, Kelantan.
(Submitted)
Abstract
Dermatological disorders are among ten major work-related illnesses. The maintenance
and support staff of healthcare industries are particularly vulnerable to occupational
exposures and cleaners have been identified as being at high risk for contact dermatitis.
This study is aimed at determining the prevalence, knowledge (K), attitude (A) and
practice (P), and risk factors of contact dermatitis in hospital cleaners. A cross-sectional
study was undertaken in August 2001 to June 2002. A pilot study was undertaken to
validate the KAP questionnaire. Two hundred and ninety seven hospital cleaners were
recruited from Hospital USM (HUSM) and Hospital Kota Bharu (HKB). Data was
collected using a (1) structured questionnaire comprising of 3 socio-demographic, 5
occupational, 25 K, 14 A and 14 P (KAP) regarding contact dennatitis; (2) medical
history and clinical examination by a dermatologist; and (3) patch test. Allergic and
irritant contact dermatitis was diagnosed based on a history of chemical exposure,
clinical examination and patch testing: a positive patch test differentiated allergic from
irritant contact dermatitis. Results indicated that the prevalence of contact dermatitis
was 7.4% (95% CI 4.7% - 11.0%). Allergic contact dermatitis and irritant contact
dermatitis constituted 41.2% and 58.8%, respectively of contact dermatitis. Majority of
contact dennatitis involved thigh, leg and feet (50.0%). Putative chemical agents
responsible for occupational allergic contact dermatitis were nickel sulphate (5 patch
positives), rubber chemicals (1 mercapto mix patch positive), preservatives in soaps (1
paraben mix patch positive) and contaminants in soaps and detergents ( 1 potassium
dichromate patch positive). Factor analysis of the KAP questions extracted the
following common factors: K: causes, clinical features, treatment, and prevention; Aand P: health-seeking behavior, safe work practice, safety policy, and use of personal
protective equipment (PPE). Reliability analysis indicated that the questions were
internally consistent with Cronbach's alpha ranging from 0.46 to 0.97. There was no
significant difference in the mean scores of KAP between 22 hospital cleaners with
contact dermatitis and 275 hospital cleaners without. Simple logistic regression analysis
showed that history of earlier hand eczema (Crude OR 8.24, 95% CI 3.31, 20.53),
wearing protective glove for more than 2 hours per day (Crude OR 2.97 95% CI
1.17,7.55) and wet work for more than 2 hours (Crude OR 5.04, 95% CI 1.85,13.74)
were significantly associated with contact dermatitis in hospital cleaners. Multiple
logistic regression analysis showed that there was a positive association between the
duration of use of protective glove for more than 2 hours and contact dennatitis
(adjusted OR 3.29, 95% CI 1.03, 10.73). The odds ofhaving contact dermatitis was 8.79
times in hospital cleaners with a history of earlier hand eczema (adjusted OR 8. 79, 95%
CI 3.15, 24.56). We conclude that prolonged use of protective glove and previous
history of hand eczema were associated with contact dermatitis in hospital cleaners.
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