A cluster randomised controlled trial of a behavioural change package to prevent hand dermatitis in nurses working in the National Health Service

Aims: 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 in at-risk nurses working in the National Health Service (NHS). Secondary aims will be to assess impacts on participants’ beliefs and behaviour regarding hand care, and on the colonisation of their hands by pathogenic bacteria. In addition, we will assess the cost-effectiveness of the intervention in comparison with normal care. Intervention: The intervention will centre on a bespoke on-line behavioural change package (BCP). This will be developed by members of the study team with expertise in dermatology, occupational medicine, nursing, and health psychology and care will be taken to ensure compatibility with current guidance on infection control. It will include advice: on when and when not to use gloves; on when to use antibacterial hand rubs; on when and how to wash and dry hands; on when to use moisturising cream; and to contact occupational health (OH) early if hand dermatitis occurs. As part of the package, nurses will be asked to form implementation intentions for performing behaviours in their workplace. These will be recorded, and participants will subsequently be reminded of them and offered the opportunity to revise them. The package will be supported by provisions to encourage adherence, such as moisturising creams. It will be actively reinforced over the course of the study by consistent messages on skin care from local OH and control of infection teams, and from line management. Methods We will test the intervention in a cluster randomised controlled trial at 35 NHS acute hospital trusts, focusing on two groups of staff: (i) student nurses who are about to start their first clinical placements, and are at increased risk of hand dermatitis from wet work because of a past history of atopic disease or hand eczema; and (ii) nurses working in intensive care units who are at increased risk of hand dermatitis because of the nature of their work. Nurses at control trusts will be managed according to what would currently be regarded as best practice, with provision of an advice leaflet about optimal hand care (also provided to the intervention group, and developed by the same team as the BCP) and encouragement to contact their OH department early if hand dermatitis occurs. However, they will not receive the BCP or active reinforcement of its messages. Nor will they routinely be offered supplies of moisturising cream over and above what is already standard practice in their trust. The impact of the intervention will be evaluated from information collected by questionnaires and standardised photographs of hands (which will be assessed for the presence of dermatitis blind to other information about the participant). 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 trust, and will take account of the paired nature of before and after comparisons in individuals. The principal outcome measure will be the difference between intervention and control trusts in the change in point prevalence of visible hand dermatitis from baseline to 12 months after the intervention. Secondary outcome measures will include: 1)The incidence of new episodes of hand dermatitis presenting to the OH department over the 12-months of follow-up 2)The difference between intervention and control trusts in the change in severity of visible hand dermatitis from baseline to the end of follow-up 3)Days lost from sickness absence and days of modified duties because of hand dermatitis per 100 days of nurse time during the 12-months o