一项预防国民医疗服务体系护士手部皮炎的行为改变方案：一项整群随机对照试验的结果

A behaviour change package to prevent hand dermatitis in nurses working in the National Health Service: results of a cluster randomized controlled trial.

作者信息

Madan I, Parsons V, Ntani G, Coggon D, Wright A, English J, McCrone P, Smedley J, Rushton L, Murphy C, Cookson B, Williams H C

机构信息

Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, U.K.

MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, U.K.

出版信息

Br J Dermatol. 2020 Sep;183(3):462-470. doi: 10.1111/bjd.18862. Epub 2020 Mar 10.

DOI:10.1111/bjd.18862

PMID:31989580

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7497001/

Abstract

BACKGROUND

Occupational hand dermatitis poses a serious risk for nurses.

OBJECTIVES

To evaluate the clinical and cost-effectiveness of a complex intervention in reducing the prevalence of hand dermatitis in nurses METHODS: This was a cluster randomized controlled trial conducted at 35 hospital trusts, health boards or universities in the UK. Participants were (i) first-year student nurses with a history of atopic conditions or (ii) intensive care unit (ICU) nurses. Participants at intervention sites received access to a behavioural change programme plus moisturizing creams. Participants at control sites received usual care. The primary outcome was the change of prevalent dermatitis at follow-up (adjusted for baseline dermatitis) in the intervention vs. the control group. Randomization was blinded to everyone bar the trials unit to ensure allocation concealment. The trial was registered on the ISRCTN registry: ISRCTN53303171.

RESULTS

Fourteen sites were allocated to the intervention arm and 21 to the control arm. In total 2040 (69·5%) nurses consented to participate and were included in the intention-to-treat analysis. The baseline questionnaire was completed by 1727 (84·7%) participants. Overall, 789 (91·6%) ICU nurses and 938 (84·0%) student nurses returned completed questionnaires. Of these, 994 (57·6%) had photographs taken at baseline and follow-up (12-15 months). When adjusted for baseline prevalence of dermatitis and follow-up interval, the odds ratios (95% confidence intervals) for hand dermatitis at follow-up in the intervention group relative to the controls were 0·72 (0·33-1·55) and 0·62 (0·35-1·10) for student and ICU nurses, respectively. No harms were reported.

CONCLUSIONS

There was insufficient evidence to conclude whether our intervention was effective in reducing hand dermatitis in our populations. Linked Comment: Brans. Br J Dermatol 2020; 183:411-412.

摘要

背景

职业性手部皮炎对护士构成严重风险。

目的

评估一项综合干预措施在降低护士手部皮炎患病率方面的临床效果和成本效益。

方法

这是一项在英国35家医院信托机构、健康委员会或大学进行的整群随机对照试验。参与者为：（i）有特应性疾病史的一年级实习护士，或（ii）重症监护病房（ICU）护士。干预组的参与者可以参加行为改变计划并使用保湿霜。对照组的参与者接受常规护理。主要结局是干预组与对照组在随访时（根据基线皮炎情况进行调整）手部皮炎患病率的变化。随机分组对除试验单位外的所有人保密，以确保分配隐藏。该试验已在国际标准随机对照试验编号注册库（ISRCTN）注册：ISRCTN53303171。

结果

14个地点被分配到干预组，21个地点被分配到对照组。共有2040名（69.5%）护士同意参与并纳入意向性分析。1727名（84.7%）参与者完成了基线调查问卷。总体而言，789名（91.6%）ICU护士和938名（84.0%）实习护士返回了完整的调查问卷。其中，994名（57.6%）在基线和随访时（12 - 15个月）拍摄了照片。在根据皮炎的基线患病率和随访间隔进行调整后，干预组与对照组相比，实习护士和ICU护士在随访时手部皮炎的优势比（95%置信区间）分别为0.72（0.33 - 1.55）和0.62（0.35 - 1.10）。未报告有不良事件。