Background: Hand dermatitis can be a serious health problem in healthcare workers. While a range of skin care
strategies and policy directives have been developed in recent years to minimise the risk, their effectiveness and
cost-effectiveness remain unclear. Evidence now suggests that psychological theory can facilitate behaviour change
with respect to improved hand care practices. Therefore, we will test the hypothesis that a behavioural change
intervention to improve hand care, based on the Theory of Planned Behaviour and implementation intentions,
coupled with provision of hand moisturisers, can produce a clinically useful reduction in the occurrence of hand
dermatitis, when compared to standard care, among nurses working in the UK National Health Service (NHS) who
are particularly at risk. Secondary aims will be to assess impacts on participants’ beliefs and behaviour regarding
hand care. In addition, we will assess the cost-effectiveness of the intervention in comparison with normal care.
Methods/Design: We will conduct a cluster randomised controlled trial at 35 NHS hospital trusts/health boards/
universities, focussing on student nurses with a previous history of atopic disease or hand eczema and on nurses
in intensive care units.
Nurses at ‘intervention-light’ sites will be managed according to what would currently be regarded as best practice, with
provision of an advice leaflet about optimal hand care to prevent hand dermatitis and encouragement to contact their
occupational health (OH) department early if hand dermatitis occurs. Nurses at ‘intervention-plus’ sites will additionally
receive a behavioural change programme (BCP) with on-going active reinforcement of its messages, and enhanced
provision of moisturising cream.
The impact of the interventions will be compared using information collected by questionnaires and through
standardised photographs of the hands and wrists, collected at baseline and after 12 months follow-up. In addition,
we will assemble relevant economic data for an analysis of costs and benefits, and collect information from various
sources to evaluate processes.
Statistical analysis will be by multi-level regression modelling to allow for clustering by site, and will compare the
prevalence of outcome measures at follow-up after adjustment for values at baseline. The principal outcome measure
will be the prevalence of visible hand dermatitis as assessed by the study dermatologists. In addition, several secondary outcome measures will be assessed.
Discussion: This trial will assess the clinical and cost effectiveness of an intervention to prevent hand dermatitis in nurses
in the United Kingdom.