Occupational skin disease (OSD) is the most common non trauma-related occupational illness accounting for approximately 14% all occupational illnesses. It may come as no surprise that food workers have among the highest rates of OSD followed agricultural production, janitorial trades such as hotels and lodging and mechanics. Food worker rates are over twice as high as other industries. Fifty-five percent of all skin problems in the industry are caused by contact with water, soaps and detergents, with a further 40% of cases arising from contact with food. When OSD occurs, almost half the time, workers compensation claims become involved with up to a quarter of those workers missing several days of work. Food handlers on sick leave take longer to return to work than employees who suffer skin problems in other professions. The medical literature is well represented with accounts of food handlers suffering from; irritant hand dermatitis, allergic contact dermatitis, contact urticaria, and protein contact dermatitis and skin infections of the hand.
Food workers affected by OSD run the full range of occupations in the industry including; harvesters, food packaging personnel, retail food preparation and catering food handlers, dishwashers and waiters. Kitchen workers at highest risk for OSD are bakers, confectioners, pastry chefs and butchers. Those business organizations with flawed skin care programs and suffering the highest incidence rates of OSD often has a significant portion of their workforce affected and unreported. Skin care experts believe that it is likely that the number of workers with work related contact dermatitis is underestimated by as much as 400%. In North America, Europe and Australia where OSD is monitored, the total costs including employee replacement and retraining is believed to run into the many billions of dollars.
Factors Making for a Perfect Storm
While genetic factors play a role in OSD, there is no way to predict who is going to develop full-blown symptoms, as it is really a matter of exposure. Often times OSD is provoked by workflows and an accumulation of factors of which it can be best described a perfect storm. Disruption of the skin barrier manifests as frank eczema (inflammation of the epidermis) or irritant contact dermatitis. These include what can best be described as hazards of wet work, detergents, prolonged glove wearing and irritating food juices. These are often combined with severe irritation or chemical burns by chlorine compounds (sodium hypochlorite) iodophors, quats or other acid sanitizers and temperature assaults of hot water, stove heat burns or scalds and ice (frostbite, chilblains). Mechanical injury from sharp food components and knife cuts can also play a role. Obviously, the severity of the damage is dependent on the type, intensity and frequency of these irritating factors.
Contact dermatitis usually appears as a rash located at the point of exposure. Acute dermatitis may have a weepy, swollen, or blistered appearance, while skin suffering from chronic dermatitis may become dry, cracked, and scaly. More severe skin irritation may cause red blisters or burns, while skin changes similar to those caused by eczema can appear over time due to exposure to weak irritants.
Some chemicals used as food preservatives such as organic acids, nitrates and aldehydes can play a part but more significant and abundant are allergen exposures that include nearly 3,000 chemical agents that are known to be capable of inducing allergic contact dermatitis. In addition to antimicrobial chemicals and food allergen such as exists in the many food components that are allergenic, such as spices, citrus fruits, mangos, garlic and onions are metals. Nickel and chrome, are the most common metals that cause contact dermatitis both of which are a common component in food processing machinery and work surfaces. When stainless steel utensils, machinery and surfaces are exposed to acidic foods, water or humid conditions, the nickel often leaches out of the metal. This has caused up to 11% of all adult workers to become nickel sensitive. Nickel is found in costume jewelry, belt buckles and wristwatches, as well as zippers, snaps and hooks on clothing so once sensitized in a food environment, daily exposures outside of work will set off skin reactions.
An important management function in order to get ahead of these types of problems to reduce turnover and business costs is workplace risk assessment as to process and facility chemical hazards as well as food allergen exposures that can lead to negative skin conditions. All control methods to limit frequency and duration of exposure, personal protective equipment and effectiveness has to be integrated into a staff education and training program aimed at addressing facility, food product or process specific problems.
Glove Protection: Sometimes a Contradiction of Terms?
Gloves protect food workers from contact with irritants and allergens and it is therefore somewhat counter-intuitive that use of protective gloves are often found to be the most common contributory cause exacerbating all types of chemical exposures. The ultimate contradiction is an allergy to rubber chemicals that may come as a consequence of trying to protect hands from other facility allergens. Using non-latex gloves does not make a facility immune to the issue, as in addition to natural rubber latex are a host of other so-called rubber accelerators consisting of activators, antioxidants, vulcanizing agents, retarders, reinforcing agents and processing aids that have allergenic properties. Like problems with metal allergies, once sensitized, clothing items, household and recreational rubber products will trigger symptoms. This is yet another reason to pay attention to preventive skin care, task specific glove selection, and proper use and change frequency. Gloves should never be used continuously and less allergenic nitrile, vinyl or polyethylene materials should be used where possible. As in the previous blog on gloves, there is no doubt that when properly used, gloves can significantly prevent cross-contamination or infectious disease transmission but it is a matter of properly managing their use.
The Good, the Bad and the Ugly
Unfortunately the skin is not an absolutely impermeable membrane and instead consists of many layers of dead cells containing keratin, a tough, insoluble protein material that is the main structural component. The epidermis overlays very vulnerable living tissue susceptible to infection when barrier function is compromised. Continuous immersion of hands in water or in gloves will cause maceration, skin defatting and loss of homeostasis. In food processing or food service environments, dermatitis is not infrequent and may take many forms from simple dry, flaking, and fissuring skin; to red, swollen, blistering, weeping, and eroded tissue. Broken skin leads to a risk of skin infection (e.g. S. aureus, Streptococcus pyogenes, Candida spp.) which will appear as red, painful, swollen skin with ulceration, oozing or pustules.
Fortunately the skin has an exceptional capacity to regenerate provided the deeper most layers are not irretrievably damaged. The basis for skin health is mild hand washing with clean dry hands maintained as much as possible with worker rotation a tool toward this end. Food workers hands should be checked regularly for signs of dermatitis and obvious skin problems should have medical treatment. Damaged skin that is not yet fully healed, remains vulnerable to further damage and can be made worse by many physical or chemical insults that otherwise normal healthy skin could easily have withstood. Rather than high turnover as a cost of doing business a more rational approach is to appreciate the complexities of skin care. Proper management of skin problems can provide a good return on investment when all factors are considered.
The Promise Delivered
Hands should be moisturized often, with creams or lotions designed for food venues in mind (will not contaminate or taint food). Hand sanitizers used frequently can help optimize skin barrier function with high quality emollients found in advanced formulas. When moisturizing creams are applied before and after work or by workers at home, particular attention should be paid to fingertips, interdigital space and wrists. The benefits of using improved skin protection in the prevention of OSD is: reduced turnover, reduced workers’ compensation claims, reduced lost workdays and improved employee safety and satisfaction.
The promise of food safety goes beyond a manager’s monitoring employees health for symptoms of diseases transmissible through food. It is achieved by managing the safety risks posed by negative skin conditions. Ultimately the health of the public is in those hands and red, sore, dry, hands generally don’t get washed. For that we don’t need a palm reader or a dermatologist but an infection preventionist. It is the wisdom of the exceptional food safety manager realizes it is the food worker who has the most actual skin in the food safety game.
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