Guest blog by Dr Finola Ryan and Dr Rachel Edgar
Work-related contact dermatitis and the COVID-19 pandemic
The effects of frequent handwashing and glove use on skin health in healthcare workers (HCWs) are well-recognised: Work-related contact dermatitis quickly established itself as a significant issue in this occupational group at the onset of the COVID-19 pandemic. King's College Hospital NHS Foundation Trust (KCH), a large London teaching hospital, saw a 9.5-fold increase in work-related skin problems in 2020 compared to 2019. With education, prevention, early identification and timely management in mind, the Trust Dermatology team established a 'walk-in' clinic as part of the Trust staff wellbeing initiative. This intervention minimised staff absences and instances of temporary restriction from clinical activities due to work-related skin problems. It ensured compliance with Control of Substances Hazardous to Health Regulations 2002 (COSHH) through information, education and training focused on skincare and handwashing, and preventing moderate to severe hand dermatitis.
Implementing the Hierarchy of Controls
Elimination of handwashing is not feasible in this occupational setting, so substitution with a less harmful substance is the next most effective control measure. Traditional management of work-related contact dermatitis includes using a soap substitute, such a Dermol 500, to replace regular soap. However, due to a lack of evidence on these preparations' virucidal activity, their use was discouraged in clinical settings during the COVID-19 pandemic. KCH collaborated with researchers at Imperial College to investigate whether or not they could effectively inactivate SARS-CoV-2, the virus responsible for the pandemic.
Testing the virucidal activity of a soap substitute
Efficacy of the two antimicrobial agents present in Dermol 500 lotion – benzalkonium chloride (BAK) and chlorhexidine dihydrochloride (CD) – had been previously demonstrated against bacteria and several viruses with an outer membrane “envelope” structure similar to SARS-CoV-2, but not at the exact concentrations, combinations and context found in this soap substitute. The easiest thing to do was to directly test Dermol 500 against SARS-CoV-2 and influenza A in a laboratory setting. We compared virus infectivity at both skin and room temperature when the virus was exposed to Dermol 500, versus commercially available alcohol-based hand sanitisers or no treatment at all, and found the soap substitute efficiently inactivates both of these respiratory viruses. In addition, we determined that similar virucidal (virus-killing) activity could be achieved with a 10 fold reduction in BAK concentration. This research will aid in the development and manufacture of soap substitutes designed for frequent use, minimising the levels of antimicrobial agents required to achieve a safe and effective product.
Occupational health physicians have unique knowledge and access to work-related health problems. Through collaboration with other disciplines, they can pose pertinent research questions to scientists with the expertise to investigate. Through a translational research collaboration, we found that Dermol 500 lotion is effective under controlled laboratory conditions, providing the impetus and scientific basis for further studies in clinical settings, and presents an exciting opportunity to have a meaningful impact on the skin health of HCWs.
The pre-print is available here: https://www.medrxiv.org/content/10.1101/2021.02.12.21251419v2
Dr Finola Ryan is a Specialist Registrar in Occupational Medicine at King's College Hospital and Trainee Representative to the Faculty of Occupational Medicine. Dr Rachel Edgar is a research group leader at the Department of Infectious Diseases, Imperial College London.