Health surveillance is used to detect the early onset or symptoms of dermatitis. The earlier a skin condition is discovered the better the prognosis. It is deemed to be secondary prevention and not as effective as the primary prevention measures outlined above. Health surveillance where used, has to be used in conjunction with these other control measures. Health surveillance can help to show that workplace control measures are working.
A pre employment health questionnaire should be completed by all those going to work with substances which can cause dermatitis. There may be limitations in employing a person who currently suffers from dermatitis.
A health assessment is usually aimed at identifying an effect of work on health, in this case skin. It may be required before a worker commences work, especially for people with a previous known sensitivity to an irritant or sensitiser used in the workplace. People with pre existing dermatitis are more likely to develop irritant dermatitis in the workplace. The person carrying out the assessment must be familiar with substances and processes used, standards of cleaning and hygiene, personal protective equipment used. The initial health assessment can be carried out by a health professional but the decision on whether an individual is suitable for a particular post is normally made by a doctor, preferably one with qualifications in occupational medicine. Dermatitis may be considered a disability and the obligations under Equality Legislation should be considered on the suitability for employment.
Routine Health Surveillance
Again the decision whether to carry out health surveillance is based on the Risk Assessment. When the Risk Assessment suggests there is the potential for an employee to develop work related dermatitis because of workplace exposure then usually health surveillance is required.
Because dermatitis is normally evident first to the individual self examining and reporting of problems is hugely important. This can only be successful if individuals know what to report and to whom. Employee education and training is vital and should include the principles of prevention, skin care and the early signs of dermatitis. It should also include who to report to, usually the occupational health nurse if present or company doctor.
Self reporting can be augmented by a skin questionnaire which should be completed again and results compared to pre employment ones. Ideally abnormal results should lead to the individual being assessed by a doctor qualified and experienced in occupational medicine or dermatology.
If health surveillance indicates that an employee has developed dermatitis, it is important to try to identify the cause. If a suspect cause can be identified and the dermatitis goes way either by avoiding the suspect substance or changing work practices, such as using gloves then usually no further action is required.
If however the condition persists, the opinion of a specialist occupational physician or dermatologist should be sought. The assessment may include an inspection of the workplace.
If allergic dermatitis is considered Patch Testing may be performed. The test involves the application of various test substances to the skin under adhesive tape that are then left in place for 48 hours. The skin is then examined on the removal of these patches and again a further 48 hours later for any response. This can help the doctor decide which allergens the employee may be allergic to and identify those that could be aggravating the dermatitis. This is normally carried out by a dermatologist.
Any new case of dermatitis may indicate that the existing control measures are inadequate and the Risk Assessment should be reviewed and any necessary changes made.