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A behaviour change package to prevent hand dermatitis in nurses working in health care: the SCIN cluster RCT

Madan, Ira; Parsons, Vaughan; Ntani, Georgia; Wright, Alison; English, John; Coggon, David; McCrone, Paul; Smedley, Julia; Rushton, Lesley; Murphy, Caroline; Cookson, Barry; Lavender, Tina; Williams, Hywel

Authors

Ira Madan

Vaughan Parsons

Georgia Ntani

Alison Wright

John English

David Coggon

Paul McCrone

Julia Smedley

Lesley Rushton

Caroline Murphy

Barry Cookson

Tina Lavender

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HYWEL WILLIAMS hywel.williams@nottingham.ac.uk
Professor of Dermato-Epidemiology



Abstract

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. FUTURE WORK: Participants had a high level of baseline beliefs about the importance of using hand moisturisers before, during and after work. Future research should focus on how workplace culture can be changed in order for that knowledge to be actioned. TRIAL REGISTRATION: Current Controlled Trials ISRCTN53303171. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 58. See the NIHR Journals Library website for further project information.

Citation

Madan, I., Parsons, V., Ntani, G., Wright, A., English, J., Coggon, D., …Williams, H. (2019). A behaviour change package to prevent hand dermatitis in nurses working in health care: the SCIN cluster RCT. Health Technology Assessment, 23(58), 1-92. https://doi.org/10.3310/hta23580

Journal Article Type Article
Acceptance Date Apr 30, 2019
Publication Date Oct 31, 2019
Deposit Date Nov 6, 2019
Publicly Available Date Nov 6, 2019
Journal Health Technology Assessment
Print ISSN 1366-5278
Electronic ISSN 2046-4924
Publisher NIHR Journals Library
Peer Reviewed Peer Reviewed
Volume 23
Issue 58
Pages 1-92
DOI https://doi.org/10.3310/hta23580
Keywords Health Policy
Public URL https://nottingham-repository.worktribe.com/output/3066703
Publisher URL https://www.journalslibrary.nihr.ac.uk/hta/hta23580#/abstract
Additional Information Madan I, Parsons V, Ntani G, Wright A, English J, Coggon D, et al. A behaviour change package to prevent hand dermatitis in nurses working in health care: the SCIN cluster RCT. Health Technol Assess 2019;23(58)

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