Fiona Warren from Oxford University Hospitals NHS Foundation Trust asks:

Emollient/soap substitute supplies: would anyone be happy to share the following information:

1.       How do you provide emollients / soap substitutes for Trust staff with skin issues – i.e. is it just purchased by the department or is it ordered through OH or other?

2.       What do you provide as a specific soap substitute?

3.       Do OH monitor this in any way?

4.       What level of skin surveillance do you offer and how? 

5.       Do you let anyone self-assess their skin for visual inspection?

Please respond direct to fiona.warren@ouh.nhs.uk and cc to admin@nhshealthatwork.co.uk.

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Answers

The department orders the soap substitute, although I usually provide the first prescription and write to MGR to continue ordering as it is not a prescription only. I use dermol 500 as it has a good microbial profile and is very kind on the skin.

We have a baseline skin surveillance at pre-employment (self-assessed) unless they declare any problems with their skin. Subsequently managers check skin of hands at appraisal. Managers know what to look out for e.g. cracking, redness or broken skin of hands so if they see a member of staff with any skin issues on hands they refer to OH.

On the NHS Network site there is some work and a dermatitis policy undertaken by Blandina Blackburn with the HSE which might be informative.

(London North West University Healthcare NHS Trust)

1.              How do you provide emollients / soap substitutes for Trust staff with skin issues – i.e. is it just purchased by the department or is it ordered through OH or other?

We only use/recommend Dermol 500 as a soap substitute (infection control are happy as it contains some chlorhexidine). We have tried various approaches over the years, including giving an outpatient hospital prescription (and the cost being charged back to the ward or department rather than the worker paying for it) but this was clumsy as required OHP’s to do repeat scripts and the pharmacy found it difficult to charge back this way. We then made recommendations to the manager that they have a worker needing this and to add to ward stock and can just order at will, but pharmacy rightly identified that there was no ongoing medical supervision, which there ought to be. So we have just settled on a new approach where we have our own ‘drugs cupboard’ (we also keep antibiotics for prophylaxis) where we hold some stock and simply sign out to workers who need it. So far, it’s really not too onerous and realistically if workers need a long-term repeat supply then I think we should be getting them down to our department and seeing them F2F every 6/12. 

 Costs absorbed into OH budget (probably less than £100 per year on dermol).

 Hand cream is avail in most clinical areas in dispensers next to soap.

 As an aside, if workers are having irritancy from scrubbing with traditional chlorhex or iodine, then we recommend Sterilium which is a gel used like hand rub and appears to be much better tolerated. 

2.              What do you provide as a specific soap substitute?

Dermol 500 only, we also stock some alcohol free sanitiser samples if workers have had irritancy from the standard stuff.  If they get on well with this we ask the manager to keep purchasing it. It’s called Tec-care and is much nicer than standard gels.

3.              Do OH monitor this in any way?

As above. We code all ‘diagnoses’ – especially work-related issues, on COHORT and pull figures to share with H&S team etc. We do have an option to note that soap substitute was recommended/given.

4.              What level of skin surveillance do you offer and how? 

We had an HSE visit a few years back which was challenging.  Since then, to meet their stipulation that all HCW’s should be under some degree of surveillance, there is a question on the standard appraisal documentation for all staff specifically about hands/skin and the appraiser will ask and look at hands. An OH referral is triggered if necessary. We probably get a handful per year of these, but I must say the organisation is really good at referring any WR skin issues quickly anyway. 

5.              Do you let anyone self-assess their skin for visual inspection?

Appraiser as mentioned above – staff are also aware from infection control and soon to be released Occupational Health mandatory training modules to seek advice if skin problems develop. Skin advice given to all clinical staff as part of standard ‘on employment’ OH check.

(University Hospitals of Leicester NHS Trust)

Template policy available here provided by the University Hospital Southampton NHS Foundation Trust.

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