OCCUPATIONAL DERMATOSES AMONG HOSPITAL CLEANING WORKERS IN SARAWAK GENERAL HOSPITAL

Transcription

1 OCCUPATIONAL DERMATOSES AMONG HOSPITAL CLEANING WORKERS IN SARAWAK GENERAL HOSPITAL Ayu Akida Abdul Rashid Master of Public Health 2010

2 pusat hidmat M kjumat Akade UNIVERS111 MALAYSlA SARAW, P.KHIDMAT MAKL.UMAT AKADEMIK 1IIIIIIIIIfirii OCCUPATIONAL DERMATOSES AMONG HOSPITAL CLEANING WORKERS IN SARA W AK GENERAL HOSPITAL AYU AKIDA ABDUL RASHID A thesis submitted in fulfillment ofthe requirements for the degree ofmasters ofpublic Health. Faculty ofmedicine and Health Sciences UNIVERSITI MALAYSIA SARAWAK 2010

3 ABSTRACT OCCUPATIONAL DERMATOSES AMONG HOSPITAL CLEANING WORKERS Ayu Akida Abdul Rashid (Occupational dermatoses are a burden to the society and may present as a long term burden to sufferers of the condition. Numerous studies have investigated occupational dermatoses among various occupations, yet little work has been done locally to examine the patterns ofoccupational dermatoses among hospital cleaning workers and the consequences of the disease on the work environment and the sufferers themselves. This study aimed to identify the prevalence of oocupational dermatoses among hospital cleaning workers and to examine the factors exposed towards the participan0 Consequences and coping strategies ofthe sufferers of the condition is also explored. This study adopts the mixed-method where both qualitative and quantitative approaches are utilized. Data were collected from 138 hospital cleaning wqrkers of Sarawak General Hospital using a self-administered questionnaire, followed by a brief physical examination of the skin and a question-guided interview of those who were identified to have occupational dermatoses. Results indicated that the prev~lence of occupational dermatoses among the study group was 27.5 percent (n=38) with a majority of 65.8 percent (n=25) having dermatitis, while the rest has occupational urticaria. Wet work, food preparation outside work and presence of atopic symptoms are related to acquiring occupational dermatoses. Recommendations for future studies were presented.

4 A BSTRAK PENYAKIT KULIT BERPUNCA DARIPADA PEKERJAAN DIKALANGAN PEKERJA PEMBERSIH HOSPITAL DI HOSPITAL UMUM SARA WAK Ayu Akida Abdul Rashid Penyakit kulit yang berpunca daripada pekerjaan adalah suatu beban kepada masyarakat dan mampu menyebabkan penghidapnya mengalami kesan jangka panjang yang tidak diingini. Pelbagai kajian telah dijalankan di kalangan pelbagai jenis pekerjaan, namun hanya sebilangan kecil yang telah dijalankan pada peringkat tempatan untuk mengkaji pola penyakit tersebut di kalangan pekerja pembersih hospital dan kesan daripada penyakit tersebut terhadap persekitaran sekeliling dan terhadap penghidapnya. Kajian ini bertujuan untuk mengenalpasti prevalens penyakit kulit berpunca daripada pekerjaan dikalangan pekerja pembersih hospital dan mengkaji faktor-faktor yang mendedahkan pekerja kepada penyakit tersebut. Kesan dan kaedah untuk menangani penyakit ini juga dikaji. Kajian ini menggunakan kaedah 'mixedmethod' yang menggunakan kedua-dua cara kualitatif dan kuantitatif. Data telah diambil daripada J38 orang peserta kajian yang terdiri daripada pekerja pembersih hospital melalui boring kaji selidik yang diisi oleh individu itu sendiri, diikuti oleh pemeriksaan jizikal secara ringkas terhadap kulit yang terdedah serta temuduga berasaskan panduan soalan kepada peserta kajian yang telah dikenalpasti menghidap penyakit kulit yang berpunca daripada pekerjaan. Keputusan kajian menunjukkan bahawa prevalen penyakit kulit ini adalah 27.5 peratus (n=38) dengan sebilangan besarnya adalah penghidap dermatitis dengan 65.8 peratus (n=25). Yang selebihnya menghidapi urtikaria. Pekerjaan basah, penyediaan makanan dan ii

5 penghidap masalah alahan adalah berkaitan dengan mendapat penyakit yang dikaji. Usulan untuk masa de pan juga disertakan. iii

6 DECLARATION No portion ofthe work referred to in this thesis has been submitted in support ofan application for another degree ofqualification ofthis or any other university or institution ofhigher learning. Signature: ~ Name: AYu. A-\(.\I?A Af:,OuL R-A-:{HIO Date: ~ I J u IV C.;). 0 I 0 IV

7 ACKNOWLEDGEMENT First and foremost, I would like to offer my sincerest gratitude to my supervisor, Dr. Zabidah Putit, who has supported me throughout with her knowledge, guidance and patience. One simply could not wish for a better supervisor. I would also like to thank the lecturers of the Department of Community Medicine and Public Health ofthe Faculty of Medicine and Health Sciences, for lending their support and guidance in completing my thesis. A special thanks to Stellar Focus Sdn Bhd, who gave me the permission to carry out my research involving their employees. Not forgetting the participants of my study, who has been tremendously generous in providing me with their patience to participate in the study. To all my course mates, who have endured the difficulties of our course together, I thank you with all my heart for the moral support and friendship. Finally, I thank my family, who has been my pillar of strength during this trying period. Thank you for understanding and giving me the support I needed to complete my thesis. v

8 LIST OF TABLES Table 1: Demographic characteristics ofstudy group Table 2: Occupational demographic characteristics ofthe study group Table 3: Characteristics ofrespondents with occupational dennatitis Table 4: Frequency and percentage ofrespondents with urticaria in relation to frequency ofurticarial episode, most recent urticarial episode and contact with rubber gloves, animals and others Table 5: Distribution ofrespondents affected with occupational dermatoses based on demographic details Table 6: Distribution ofrespondent affected by occupational dennatoses based on demographic details Table 7: Person Chi-square analysis ofatopic symptoms ofrespondents Table 8: Distribution ofrespondents affected by occupational dermatoses based on exposure factors Table 9: Person Chi-square analysis ofatopic symptoms ofrespondents Page vi

9 LIST OF GRAPHS Page Graph 1: General health (self-assessment) ofrespondents 29 Graph 2: Percentage ofrespondents with eczema based on major activity at 30 work Graph 3: Percentage ofrespondents with urticaria based on major work 33 activity vii

10 KEY TO TRANSCRIPTIONS The following abbreviations and conventions have been used in the presentation of research findings: Italics Represent the interview data from the study participants. The original text was in Malay and was translated by me. However, where it is not possible to translate adequately, the spoken Malay language is retained. Names Pseudonyms are used for the study participants..,/1.. Indicates material deleted from the interview excerpts. A pause during the participants interview. [ ] Denotes researcher's alteration for clarity viii

11 Pu at Khidmat Maklumat Akad~n I UNTVERSITI MALAYSIA SARAWAK TABLE OF CONTENTS ABSTRACf ABSTRAK DECLARATION ACKNOWLEDGEMENTS LIST OF TABLES LIST OF FIGURES KEY TO TRANSCRIPTIONS TABLE OF CONTENTS ii iv v vi vii viii ix Chapter 1 Chapter 2 Chapter 3 Introduction 1.1 Introduction Background Purpose ofstudy Statement ofproblem Research Questions Objectives ofstudy Hypothesis Conceptual Framework Operational Definition 7 Literature Review 2.1 The Global & Local Scene Deciphering Occupational Dermatoses Cleaning Work & Workers 13 Methodology 3.1 Introduction M ethodo 10gy Study Design Instrument for Measurement Population and Sampling Inclusion Criteria Exclusion Criteria Ethical Consideration Data Collection Data Analysis Dependent Variable Independent Variable Conclusion 24 ix

12 Chapter 4 Results 4.1 Introduction Descriptive Analysis Occupational Dennatitis Occupational Urticaria Chi-square Analysis Demographic Details Atopic Symptoms Exposure Factors Consequences and Coping Strategies Introduction Consequences of Occupational Dennatoses Biological Consequences of Occupational Dennatoses Psychological Consequences of Occupational Dennatoses Social Consequences ofoccupational Dennatoses Economic Consequences of Occupational Dennatoses Coping Strategies ofoccupational Dennatoses Summary 54 Chapter 5 Chapter 6 Discussions 5.1 Introduction Discussion offindings Consequences and Coping Strategies of Occupational Dennatoses Consequences Coping Strategies 63 Conclusion 6.1 Introduction Summary Conclusions Limitations Recommendations 67 REFERENCES APPENDICES APPENDIX A: Self-administered Questionnaire APPENDIX B: Borang Kaji Selidik APPENDIX C: Interview Guide For Participants APPENDIX D: Consent Fonn APPENDIX E: Letter ofapproval to Conduct Research x

13 CHAPTER 1 INTRODUCTION 1.1 Introduction Occupational dermatoses have long been a silent issue in the Malaysian scene. It is deemed by many as an unnecessary consequence of work and to the professional body, it poses as a challenge to manage. Many are unaware and subsequently ignorant of the impact that the condition may be to a worker. It is a common disorder but it is often overlooked by physicians. Occupational dermatoses are any skin disorders that are directly caused or significantly aggravated by workplace exposures. According to the Worker & Environment Health Unit of MOH Malaysia (2008), occupational dermatoses carry the meaning of skin diseases primarily caused by occupation. It encompasses from contact dermatitis to occupational skin cancer. A big portion of workers affected by occupational dermatoses are those involved in occupations that require a person to be in contact with chemicals, those dealing with wet work and those in contact with any agents that may pose as possible irritants (Soder et ai., 2007). These are usually those involved in professions such as health care workers, cleaning and kitchen employees, hairdressers, cosmetologists and food service. Despite current knowledge on the pathogenesis, diagnosis, treatment and preventive measures of occupational dermatoses, affected workers often endure over a long period of time and will 1

14 require extensive dennatological care (Schwanitz et ai., 2002). These conditions are usually diagnosed often too late into its progress and may be difficult to manage effectively. Possible consequences of occupational dermatoses are numerous, ranging from cosmetic disfigurement to life endangering conditions (Nixon, 2005). This is a threat to the productivity of a country as those affected are mainly from the productive age and thus measures must be taken to overcome these problems (Soder et ai., 2007). However, in order for these measures to take place, awareness of the condition must be instilled upon those involved and what better way to do this other than to expose the prevalence of this condition in our working community. This chapter provides the context of the study. It briefly describes the demographics of participants involved and explains how the particular research emerged. It provides a review on issues related to the focus ofthe study. It also presents the review of the relevant literature and its context, while at the end, research questions, hypotheses and objectives of the study will be delineated Background This research was conducted among cleaning service workers in Sarawak General Hospital. Sarawak General Hospital was chosen as the place of study as the cleaning service workers are allocated work at different workstations, including the general wards, specialized wards such as intensive care units, clinics, operating theatres, laboratories and other facilities within 2

15 the hospital grounds. Their job description carries them through various cleaning tasks and exposes them to diverse cleaning agents and other physical aspects of cleaning. They are supplied with a cleaning cart and equipped with personal protectiveequipments, which are mainly aprons and gloves. Currently, cleaning services of the Sarawak General Hospital are contracted out to private cleaning companies. The hospital cleaning workers are employed by one local cleaning company, which provides cleaning services to the hospital at all wards and facilities at the hospital. There are approximately 240 cleaning service workers, with a predominance of female workers. Female workers make up approximately eighty percent of total employed hospital cleaning workers. The remaining twenty percent are male workers. From anecdotal reports, it was gathered that about half of these workers have been with the company for more than three years while the other half have been working for the company for less than the time. They are from various age groups and most live in Kuching. They are supervised by assigned supervisors who will delegate them to their workstations and determine their working hours and schedule. 11 Purpose of Study The purpose ofthis study was to gather in detail all the necessary data regarding occupational dermatoses among hospital cleaning workers. This data would then be utilized to explore certain aspects of occupational dermatoses, encompassing socio-demographic determinants ofsufferers, common skin manifestations, exposure and exacerbating factors, as well as the 3

16 consequences and coping methods. As an establishment that thrives on being clean and hygienic, it is imperative that a hospital is ensured of these qualities in those who are responsible in maintaining the cleanliness of the hospital. However, the standards set for this is easily compromised if the workers who are responsible for the cleaning tasks are handicapped by occupational skin conditions. "The Sick Worker Effect" is a condition that is often overlooked among workers but it has a considerable amount of influence on how a work is performed and consequently may be affected in terms of quality or productivity (Sterling et.al., 1990). It is because of this particular reason that this study would like to explore; to explore the link between occupational dermatoses and the consequences that a worker could suffer from. From this relationship, the details and extent to which these skin conditions can be to an affected individual is explored. Thus, preventive measures can be taken up early and suited to the affected group, rather than generalizing all preventive measures without taking into account the specific needs ofthese groups. 1.3 Statement of Problem Occupational dermatoses are very much on the rise as reported by many developed and developing countries (Rantanen, n.d.). It is a public health concern especially as it involves the productive age group (Meding et al., 2005). Although it is one of the most common occupational diseases, it is still poorly managed, in terms of investigations, treatment and prevention. The main factors that point out the importance of occupational dermatoses as 4

17 Pus:u Khidmat Maklumat Akademik UNlVERSITI MALAY fa SARAWAK diseases that have a public health impact are that it is common, often with poor prognosis and that they result in a striking economic impact for society and for the affected individual since they affect employment and other activities outside the scope of one's career (Koch, 2001). They are also diseases that are modifiable to public health interventions (Nixon, 2005). With the lack of epidemiologic information on occupational dermatoses available in Malaysia, this study would be very beneficial for future needs. Therefore, this study was an attempt to identify the prevalence of occupational dermatoses among hospital cleaning workers and the factors influencing its prevalence, with special focus on the consequences and coping methods ofthe problem to the study group. 1.4 Research Questions In view of the scope of the problem, the study aimed to know the factors that influence the occurrence of occupational dermatoses among hospital cleaning workers and the consequences and coping strategies of the affected cleaning workers with regards to their skin problem. In due course, all this was gathered in hopes of gaining better insight on how occupational dermatoses may affect the work performance ofa hospital cleaning worker and the impact to their surroundings. Hopefully, it would be able to answer the pressing research question of: Will occupational dermatoses affect work performance, how much so and what are the consequences? This has led to the formation ofthe specific objectives ofthe study. 5

18 1.5 Objectives of the Study General Objectives To gain knowledge on occupational dermatoses among hospital cleaning workers Specific Objectives To assess the prevalence ofoccupational dermatoses among hospital cleaning workers ofsarawak General Hospital To identify the socio-demographic factors influencing the prevalence ofoccupational dermatoses To determine the types ofexposures related to occupational dermatoses among hospital cleaning workers in Sarawak General Hospital in order to assess the potential for dermal exposures To explore the outcomes ofoccupational dermatoses and subsequently the coping methods among the proposed study group. 1.6 Hypothesis Hypothesis 1: Socio-demographic difference is not related to developing occupational dermatoses Hypothesis 2: Exposure factors are not related to developing occupational dermatoses. 6

19 1.7 Conceptual Framework The diagram below shows the framework between the dependent and independent variable of the study. i Environment I I I I ~ Individual worker I + OCCUPATIONAL DERMATOSES I Type of work i I I I Outcome I I Based on framework for occupational injury by International Labour 1.8 Operational Definition Occupational Dermatoses Occupational dermatoses are any abnormality of the skin induced or aggravated by the work environment Exposure Factors Exposure factors are any elements in the surrounding that may cause or form the foundation ofdeveloping occupational dermatoses. 7

20 1.8.3 Hospital Cleaning Workers Hospital cleaning workers are the workers who are employed to carry out specific cleaning tasks at the hospital. 8

21 CHAPTER 2 LITERATURE REVIEW Occupational dennatoses or occupational skin disease, as it is widefy known as, is a group of diseases that affects the skin, occurring among workers. It is a consequence ofexposure from the workplace or the work itself According to The National Skin Centre of Singapore (1995), an occupational skin disease (OSD) is any skin disorder which is caused by a person's work. In fact, it also states that a person who has pre-existing skin disorders but condition is worsened by occupation are also considered to occupational dennatoses or skin disease. Occupational dennatoses can be seen in vanous fields or sectors of work. The ones commonly implicated are those involving chemical usage, wet work and use of personal protective equipments. It is also often seen in certain industries especially fanning, manufacturing and health care, among others. Singapore has shown that the most common industry with dennatoses complaints are those related with wet work (Yen and Goon, 2006). In Northern Bavaria, high-risk occupations for an occupational skin disease include cooks, painters and varnishers, metal processors, mechanics, assemblers, construction and cement worlcers, housekeepers, restaurant business and cleaners (Dickel et ai., 2001). Malaysia has yet to come up with such a list of industries commonly associated with occupational dennatoses among workers. 9

22 1.1 The Global and Local Scene On a global scale, there are a staggering number ofapproximately 68 to 157 million new cases of occupational diseases per year cumulatively which is caused by various exposures at work (WHO, 1998). From this figure, a third of these new cases will go on to be chronic diseases of various body organs owing to assorted work exposures (WHO, 1998). In industrialized countries in the western hemisphere, the annual rate of new occupational skin diseases is estimated at approximately new diseases per 1000 employed persons per year (Diepgen 2003; Diepgen and Coenraads 1999). The World Health Organization (2001) has projected that a large number of occupational diseases go undiagnosed and unreportedl European Agency for Safety and Health at Work (2001) also reported a something of similar effect, and that is the number and extent of skin disorders is often underestimated. Hence, the number of cases reported may just be the tip ofthe iceberg with the major bulk being still unnoticed. Worldwide, occupational dermatoses have gained importance in work-related diseases, coming in second place to occupational respiratory diseases. They are among the most frequent workrelated diseases in most industrialized countries (Diepgen, 2003). According to the European Occupational Diseases Statistics (2001), in 2001 skin diseases accounted for 11.2 percent of all occupational diseases in Europe. Similarly, occupational skin diseases have headed the list of reported occupational diseases in Austria and Germany for many years (Winker et ai., 2007). In 2001, skin diseases represented almost one-third of the occupational diseases reported in Gennany (Dickel et al. 2004). In neighboring Singapore, the incidence for occupational skin 10

23 diseases diagnosed at the National Skin Centre was 62.5 cases for the year 2003 (Yen and Goon, 2006). In Northern Bavaria, it was observed that that the overall incidence rate was 6.7 cases per 10,000 workers per year in all occupational groups (Dickel et ai., 2001). According to the 2008 Annual Report from the Department of Occupational Safety and Health Ministry of Human Resources (n.a., 2008), the most frequent work-related investigations in Malaysia in the year 2008 were for occupational noise induced hearing loss with 169 cases compared to only 120 cases in This is followed by occupational skin diseases which recorded 70 cases compared to 192 cases in The findings are different from 2007 in which occupational skin diseases was the commonest occupational disease investigated followed by occupational noise induced hearing loss. However, this data did not actually mention the prevalence of each of the condition, merely the number of investigations done on each of the work-related ailments. Thus, the decline in number of investigations done in 2008 as compared to those done in 2007 in a way may reflect the level of consciousness towards occupational dennatoses. Elsewhere, there has been an increasing awareness of occupationa] dermatoses. Despite the current knowledge on the management of this condition, affected employees suffer frequently over a long time period and will therefore require extensive dermatological care (Schwanitz et al., 2002). It is hoped that early detection may actually enable the healthcare providers to provide the necess8l)' care for the skin conditions affecting workers. It may actuauy reduce the cost of treating a skin condition, which may be very difficult to treat in the long run, as occupational dennatoses have a tendency to be chronic in nature (Meding et al., 2005). In 1985, Mathias 11

24 (1985) reported that the total annual costs ofoccupational contact dennatitis were estimated to be from $222 million to $1 billion in the US (as cited by Chew and Maibach, 2002). This clearly implies that occupational dennatoses may be a potential economic burden to a country if it is not dealt with early. 1.1 Deciphering Occupational Dermatoses Early recognition and diagnosis of occupational dennatoses is necessary to reduce the suffering from this often preventable and debilitating condition (Nixon, 2005). Hence, it is imperative that a gargantuan effort is made to explore and understand the factors that may cause this condition. Wet work, use ofcleaning chemical agents and the use ofpersonal protective equipments (PPE) have been implicated in causing occupational dennatoses (English, 2004). Although this has been established, there have been many contradictory issues over the years. A good example of this is the use of personal protective equipments. It has been suggested as one of the ways in which it is thought to shield from occupational dennatoses (Koch, 2001). This includes the use of gloves, face shields, goggles, aprons and boots. However, in many instances, workers are adversely affected by the protective equipments, for example allergies to latex gloves. According to a study, among those who had skin disease, there were significantly more who used rubber gloves than among the rest (Hansen, 1982). Thus, it may imply here that the use of protective pves may be the source or root of the problem for occupational dennatoses. It may deter the cleaning service workers from using them in their subsequent work. In fact, a study done in Singapore by researchers at The National Skin Centre found that the use of PPE is associated 12