Special periodical medical examinations will trigger and enforce awareness and avoiding behaviour regarding the exposure to irritants and potential skin hazards as well as the proper use of protection equipment and barrier creams. However, for the continuous risk stabilization, an appropriate behaviour, individual awareness of risks as well as communication and behaviour patterns within the production teams are decisive . To enforce risk awareness, the self-assessment of the hand eczema risk is a simple but effective tool. Within a skin protection campaign in a department manufacturing motor and chassis parts of the car industry, 4 questions concerning the self-assessment of hand eczema risk were answered by 2,102 workers with the following results:
In order to maintain risk-adjusted behaviour patterns, the communication within the production teams has to be influenced. Team leaders may play a central role in the prevention of occupational skin diseases, if they are instructed adequately. In the example given above, the leaders of 237 production teams were used as distributors for a brochure containing self-assessments of hand eczema risk, use of barrier creams at the workplace and at home, as well as some risk-group- and exposure-related advice for skin protection and medical care. Finally, a small competition was included. All team leaders were trained about the aims, objectives and the organization of the campaign. Then each team leader distributed the brochures in his production team. During regular team meetings, the questions were discussed and answered. The return of the questionnaire part of the brochure was again organized by the team leaders, and a return rate of 94% (2,102/2,236) could be achieved in this way. In the next step, the team leaders were responsible for the feedback of the campaign results to the workers. At the team meetings, the proportion of subjects with susceptible skin, the hazards at the workplace, adequate behaviour and skin care were discussed. A central issue in this discussion was that only 48.2% of the workers with and 30.9% of those without a history of hand eczema had used the freely available barrier creams twice a day and more (once a day and more:
72.0%/56.5%). Experience of hand eczema was the most important factor for the frequent use of barrier creams, but on the other hand there were 23.2% of workers with a history of hand eczema, who neither used barrier creams at the workplace nor at home.
To analyse the success of this procedure and to give basic information for the management, evaluation processes are essential. A low or decreasing consultation frequency of the workers with the companies' occupational physicians does not automatically indicate the success of such measurements, since there is a large number of unrecorded cases of hand eczema in a plant's population. To intensify awareness will mean an increase in consultations. Therefore, the evaluation of the amount of distributed barrier creams at regular intervals is a more reliable tool regarding skin protection behaviour. As a result of the skin protection campaign and the following team meetings in autumn 1994, the consumption of barrier creams could be increased (fig. 4). One year later, however, the consumption of barrier creams decreased again. By the distribution of an additional brochure (content: general information about skin hazards and preventive measures) and a well-accepted (not fatty) additional barrier cream, it was possible to stabilize the individual skin protection on a significantly higher level than before the first skin care campaign. The monitoring of the consumption of barrier creams was also differentiated by subdepartments and shown to the management regularly. If a commitment to prevention of hand eczema is established in the management, the consumption of barrier creams is a well-accepted tool in risk management. The preventive effects may result from the barrier creams themselves. On the other hand the use of barrier creams indicates that workers are aware of risks and will also avoid skin hazards by adequate behaviour.
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