A female employee working in a school kitchen had developed signs of dermatitis. Both hands were affected and there were patches of broken and weeping skin. She could not continue to work and was forced to take sick leave.
It was considered that the dermatitis may have been caused by her daily routine involving food preparation, cooking, washing dishes and wiping down surfaces. Due to food hygiene requirements, she regularly washed her hands.
The problem appeared to have arisen even though they had the following control measures in place:
- wearing cotton liners under normal standard washing up gloves, of a rubber base;
- washing up water was no hotter than 50-60oC;
- chemicals were being used according to policy;
- a sensible skin care regime was being adopted.
The employer investigated what else could be done to prevent the dermatitis. The investigation focused on finding out:
- if the detergent used was actually contributing to the dermatitis;
- if the glove being used may be contributing to the dermatitis;
- if the employee is allergic to any of the food ingredients.
The initial investigation was carried out with the help of a 'skin care questionnaire' but unfortunately they were still unable to identify the cause of the dermatitis. As an initial precautionary measure she was supplied with an alternative pair of nitrile reusable gloves but this did not lead to improvements.
At this stage expert advice from the occupational health service was sought resulting in patch testing for potential causative agents.
Patch tests confirmed that the employee had sensitivity to plant materials, in particular to lettuce. It was also felt that the washing up detergent could have played a part in the sensitisation of her hands as it emerged that she did not always wear gloves when wiping surfaces down using a cloth.
On her return to work the following procedures were put in place:
- her skin condition was closely monitored;
- all existing control measures remained in place, but she also avoided contact with lettuce in any way;
- she continued to use nitrile gloves for work activities;
- regular application of prescribed creams.
- Work-related dermatitis brought under control and further sickness absence avoided.
- Lessons learnt for dealing with future cases and less money spent on sick pay.
- Return to work policy ensured that the employee's skin was monitored very closely, reducing the likelihood of future problems.
This case demonstrates the importance of the combination of early identification, careful management of skin care, adequate control measures for reducing expenditure on medical referral costs and sickness absence. There was also a commitment on the employee's part, to work with the employer to protect her health and income.
Hampshire County Council Catering Services have kindly allowed HSE to publicise this case study.