Is lack of knowledge about skin exposing workers to occupational skin conditions?
Hand protection takes more than gloves, yet workers often wear a pair for long periods without questioning their effectiveness or resulting skin damage. BOHS skin expert, Dr Helen Taylor, discusses how having a greater understanding of skin can increase protection.
Hand protection is sorely underestimated. When most people think of hand protection, it starts and stops with gloves, typically to prevent cuts or damage from substances – but proper, effective hand safety involves so much more than that.
Of course, any safety officer worth their salt will have put the hierarchy of control measures into action many times over as a means to minimise or eradicate exposure to such risks, and finally would have supplied gloves to workers as the last step in the plan. And yet, even with all the rules followed and the correct gloves in use, the average safety officer is unlikely to have a deep enough understanding of skin to know how gloves themselves can introduce problems for wearers. This knowledge gap increases the chance of workers developing an occupational skin condition such as dermatitis. And while safety officers can’t be expected to become experts in skin care, clear guidance on effective skin management and an awareness of the issues of prolonged glove wearing can help close the gap and improve overall hand protection strategies.
The first step is learning how gloves fail, according to skin expert Dr Helen Taylor, director of consulting firm Enviroderm and skin expert at the British Occupational Hygiene Society (BOHS). Taylor has a PhD in skin health surveillance and at Enviroderm, she works with organisations, from engineering firms to manufacturers, mines and quarries, to help address the safety controls that lead to skin exposure and damage. This often takes the form of in-situ workplace assessments and safety training. Taylor says, if your approach to hand protection is telling everyone to wear gloves, you’re missing the mark.
There are four ways in which gloves fail
1. Misuse
2. Physical damage
3. Degradation
4. Permeation.
The four ways gloves fail
In her work Taylor has witnessed an array of glove misuse, from using the wrong type for the task to modifying the glove in a way that reduces its integrity. “We've got pictures of people using cotton and leather gloves when working with chemicals, which is an obvious wrong use, but people also modify gloves. I have a picture of somebody at work who had cut the fingertips off their chemical protective gloves. When you look at it seems funny,” she says, “but it’s really not”. Taylor explains how, when viewed out of context, these images of people using compromised protective wear could suggest that they are stupid, but that’s not the case. More often than not it represents a lapse in judgement, when in needing to perform a task this appears to be the quickest solution, and upon reflection the person realises their mistake.
It’s human nature to look for shortcuts. “These individuals are in no way unintelligent, but in their mind, in that moment it made sense.” But glove misuse can also be wearing a glove that’s the wrong size so it’s too short to cover the whole hand, or blowing into a glove to open it up thereby filling it with bacteria and moisture, and certainly storing gloves in the wrong place, for instance alongside chemicals or in direct light. But a very common issue is simply not putting them on or taking them off correctly.
Correct donning and doffing each and every time is a surprisingly high area for glove misuse. Taylor recalls some incidents on the extreme side – including when asking to see a sewage worker’s hands and he used his teeth to pull his gloves off – but says that, in general, it is the action of removing both gloves without touching the outer sides that presents the challenge. And this was highlighted by a demonstration at a BOHS conference some years ago, where a fluorescent tracer was put on gloves and participants were invited to take them off carefully. Their hands were then checked with a lightbox to see where the tracer fluid had reached, and the extent of ‘contamination’. Inspired by this, Enviroderm developed their own version to support training programmes.
“It’s quite remarkable how many people fail to take gloves off without contaminating their skin. Some are quite extreme with a 50% or 76% failure rate,” Taylor says. “But you do have the other extreme where we’ve tried this at organisations that have good glove training and then we see a failure rate of around 6%. It’s about understanding how the gloves are used, to put them on, take them off properly.”
Physical damage and degradation
Hand protection has its expiry date as with any PPE, and of course that will depend on the function and material of the glove. But once physical damage, be it a tear, cut or rip, has occurred, that item is no longer fit for purpose and must be replaced. Less easy to spot and remedy however are very small, pinprick-sized holes, but they may not mean an outright fail. Taylor explains that pinhole damage may be allowable up to a certain percentage, according to the manufacturer and testing authority’s advice, but recommends finding a way to regularly check gloves, perhaps using water if appropriate or compressed air if possible, just not blowing into them with your mouth. Degradation of the material is an issue that can be missed for some time, but it is likely to occur if plastic gloves are used or stored in areas with high levels of UV light, or if there is limited information about how they handle chemicals, or this guidance is ignored.
And then there’s the problem of permeation where, Taylor says, “the glove looks absolutely normal, but the chemical goes through at a molecular level and comes out on the inside”. There's no glove material that is unaffected by all chemicals, she explains, so when integrity tests are carried out it will be for a number of specific chemicals, not all chemicals and mixes which is very likely to occur in the workplace, so it is recommended to seek out specific ones for the exact mix of chemicals being encountered or to enquire from the manufacturer. Glove permeation is tested under the EN 374 standard, where the flow rate is measured to identify at what point molecules break through the glove barrier to the inside. But, Taylor cautions, the standard requires testing for 480 minutes, or eight hours, “which when you think about it means the glove is only tested for one shift and in many workplaces they may wear them for a lot longer than that. The gloves may last significantly longer, of course, and the standard test is a starting point, but like any standard it has fixed limits and those limits don't always fit with your workplace. That's where you have to use that testing data as a guide for what you can do with the glove.” For instance, she explains, testing is generally static and performed at 23°C so when deciding on a reasonable lifespan of a glove you have to factor in thinning of material due to movement plus a higher body temperature. There is also whether it will be used for splash protection or non-contact tasks, in which case it is likely to last longer than the guide, whereas full immersion work will significantly decrease it. Many manufacturers go beyond the standard so it is worth speaking with them about your needs beforehand.
Allergies and aggravations
In general, these four aspects of glove failure rely on assessing the work, the worker and the product, but they don’t take into account the user’s general health, for example if they are working in an environment that triggers their allergies. Taylor says any allergic reaction relies on bioavailability on the surface to pass through the skin. “That goes for both allergic contact urticaria and allergic contact dermatitis. A good example of allergic contact dermatitis is if somebody has a nickel allergy and they handle coins for an hour they may start having a reaction because there's free nickel ions in most coinage. But they will usually have no problem with stainless steel because the nickel is so tightly bound into the alloy that there are no free nickel ions. This is where protection and control in the workplace comes in, where you try to eliminate the irritant either getting to the skin or going through the skin. If it's not in a form that can pass through the skin and trigger a reaction, there will be no reaction.”
It’s also possible to develop new allergies and other health problems due to exposure to certain substances, for instance, Taylor says “where you've got respiratory exposure, you often have skin exposure” and that “these issues are often viewed in isolation but actually they are linked”. The whole working environment is linked, she adds, saying that exposure to substances like ototoxic chemicals can affect your hearing and make you more susceptible to ear damage from noise, so a more comprehensive protection plan is needed for these.
Another concern is how to manage water contact because water itself is a mild irritant so having wet or excessively moist hands can cause hyperhydration. As Taylor says, “if you have your hands in water or in gloves for more than 25% of your work time, you need to consider it a hazard”. Part of this could be down to the wearer unintentionally introducing moisture into the glove, through blowing into it or by applying too much lotion which is then occlusive and causes the hands to heat, sweat and sit in their own moisture that cannot evaporate away. Of course, a certain amount of vapour release is natural and unavoidable.
“If you think about it, your natural oils don't feel super greasy all the time and a moisturiser is just replicating that – you wash your hands, you remove the oils, you replace them. But I wouldn't recommend applying moisturiser if putting your hands in gloves because a large component of any moisturiser is water, so even with a small amount I would be adding to the problem,” Taylor says.
Further, basic changes like making sure to properly, thoroughly rinse off soaps and not to wash in very hot water can help too, as these only maintain the cycle of drying out and moisturising. Skin has two layers of fat lipids on the surface and very hot water won’t kill bacteria but it will break down this natural lipid barrier “just as you do when you put hot water on dirty dishes to melt away the grease”, causing discomfort and a need for more lotion, she adds.
And if you have to wear gloves for long periods, the best prevention against hyperhydration, she says, is to wear an additional cotton liner glove to take the water away from the skin. This may require going up a size to fit both as the liner should be entirely inside the outer glove and not poking out, and if more dexterity is needed, you can cut the fingertips off the cotton liner. She also cautions that this requires regular changing as once that cotton is wet, it’s no longer absorbing and is actually holding moisture against the skin.
What can be done?
When it comes to skin irritants, these issues can rarely be solved with one sweeping solution or action. “It usually takes lots of little things,” says Taylor, “a little bit of improving skin care, it's improving protection, it's eliminating exposure. But one key thing is education”, she says, which extends across managers, the workforce and also the purchasing department to ensure all parties fully understand the pitfalls of properly buying and correctly wearing gloves.
Industry also needs a strong push to encourage more targeted training in this area and to try to challenge people's perceptions, or misconceptions, especially in highly male-dominated sectors where skin care is considered cosmetic and not an occupational hazard. This requires training that is interactive but more importantly relatable. Because why talk about niche chemicals that only a few people may encounter when there are so many real-world examples that everyone would recognise from home?
Lastly, Taylor says, ask yourself, do you really need to wear gloves? Why are you wearing them? This can clash with many organisations’ protocols and the concept of safety because when walking around a factory or construction site, you may be at risk of grasping at or even falling onto a dangerous item. However, in some industrial settings you aren’t likely to be exposed to hazards unless deliberately handling them, therefore the guidance could be revised to reduce the glove wear time for non-contact workers.
“I understand the rationale because it's a behavioural issue in the workplace to instruct everybody to wear a pair of gloves all the time, and therefore it's about educating people so they understand what they’re doing and why, then they’re more likely to do it. Because we need to use gloves where we need to use them – but if we don't need them, don't use them.”
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