Evaluation of Local Authority Campaign Work on Dermatitis in Hairdressing

1. Evaluation of Local Authority Campaign Work on Dermatitis in Hairdressing East Riding of Yorkshire & Hull City Councils Prepared by the Health & Safety Laboratory

2. Use your mouse or press the right/ left arrows to move forwards / backwards Main menu Results Methodology Introduction & Aims Information Conclusions

3. Introduction • At some stage in their career 35-40% of hairdressers in GB experience dermatitis • Dermatitis occurs most frequently amongst trainee hairdressers • Local authorities in GB have worked in partnership with HSE and the hairdressing industry to address this problem • East Riding of Yorkshire and Hull City Council have campaigned to advise hairdressing businesses, colleges, and training providers about the causes and risk of dermatitis in hairdressing Introduction Chris Dunnachie & Elizabeth Smith East Riding of Yorkshire Council Deborah Read Julia Deighton Hull City Council Project delivered by: Gareth Evans & Shamim Rahman Occupational Hygiene Unit, Health & Safety Laboratory Main menu

4. Aim: To evaluate the campaign work carried out by East Riding of Yorkshire & Hull City Council on hairdressing and dermatitis • Objectives: • To use a questionnaire to assess the use and uptake of guidance provided as part of the campaign • To share with the wider LA community examples of good practice from this campaign and to take stock of those aspects that were not productive • Participants: • Hessle High School Beverley College • Goole College David Lister College • East Riding College Hull College • Newland School for Girls Prospect Training • Immingham Oasis Academy Freedom Centre • St Mary’s Walk Aims & Objectives Main menu

5. In 2006 East Riding of Yorkshire & Hull City councils started proactive work on dermatitis in hairdressing. • In June 2008, East Riding of Yorkshire Council asked HSL to deliver a training course on dermatitis in hairdressing. The meeting was attended by local authority inspectors from East Riding of Yorkshire and Hull City Councils, and by lecturers from local education colleges and training organisations. • The course encouraged staff from East Riding Council and Hull; City to carry out and evaluate the impact of their work on dermatitis amongst hairdressers. History of project Main menu

6. Methodology: Questionnaire • Three questionnaires (for hairdressing salon staff, college students and college lecturers & trainers) were developed by HSL • The questionnaires consisted of ~20 'open' and 'closed' questions to assess the value of the DVD and guidance to the respondents • Paper copies of the questionnaires were circulated by East Riding of Yorkshire & Hull City Councils, and the completed questionnaires were returned to HSL for analysis Main menu

7. Methodology: Study population • Students: 432 students participated from local authority colleges and training providers • College lecturers & trainers: 23 staff participated from local colleges and other training providers • Hairdressing salon staff: 252 salons from East Riding of Yorkshire and Hull City Council participated Main menu

8. Methodology: Collection & analysis of data • Data was collated using SphinxTM survey software and checked for integrity • Summary data was analysed for significance by the Mathematical Science Unit at HSL • Frequency tables and statistical tests of the proportion being equal to 0.5 (i.e., no difference) were performed. • Probabilities greater than 1 in 20 are reported as significant • For questions that used a rating scale, negative responses and neutral responses (1 & 2 & 3) were combined and compared to positive responses (4 & 5) Main menu

9. Results: Hairdressing salons, students, teaching staff • Results: Hairdressing salon staff • Results: Students • Results: Teaching staff Main menu

10. Hairdressing Salon Staff Results: Feedback about DVD Number of hairdressing salons participating 252 Number of Councils participating 2 % response Participants from East Riding of Yorkshire 191 69% Participants from Hull City Council 61 41% Type of business Hairdressers 232 Barbers 20 How the DVD was used Training new staff Training staff Other activity* 5% 75% 20% * Examples included:For personal use; for self employed staff; to update knowledge; as a health & safety resource. Results menu

11. Hairdressing Salon Staff Results: Feedback about DVD 1) How would you rate the DVD for raising awareness to dermatitis & glove use? Yes No 79% 21% 2) In your opinion has the DVD helped you understand the causes of dermatitis? Yes Undecided No 74% 6% 20% 3) How useful did you find the following sections of the DVD? Maxine’s story Useful Not useful 58% 42% How to select, use, and remove disposable gloves Useful Not useful 74% 26% Looking after your hands (using moisturising creams & skin checks) Useful Not useful 74% 26% = Significant difference Results menu

12. Hairdressing Salon Staff Results: Feedback about DVD • 4) In your opinion has the DVD persuaded you to use: • Different working practices to prevent dermatitis? • Yes Already aware No • 24% 75% 1% • Longer non-latex disposable gloves (e.g., for washing hair)? • Yes Already aware No • 25% 61% 14% • Moisturising cream to protect skin? • Yes Already aware No • 14% 85% 1% • Regular checks for signs of damaged skin? • Yes Already aware No • 29% 68% 3% = Significant difference Results menu

13. Hairdressing Salon Staff Results: Impact of guidance, information & training 5) Have you read the leaflet “Looking after your hands: wearing disposable gloves”? Yes No 72% 28% If yes has the information in the leaflet persuaded you of the benefit of using non-latex disposable gloves (vinyl or nitrile)? Yes Already aware No 43% 47% 10% Has your business obtained the HABIA Health & Safety Award? Yes No 27% 73% Do you use the HABIA guidance booklet “Dermatitis and glove use for hairdressers”? Yes No 41% 59% As part of future training activity will you use the DVD with new starters? Yes Already aware No 84% 8% 8% = Significant difference Results menu

14. Students Results: Feedback about DVD % response Number of students participating 432 ~90% Number of colleges participating 6 Number of training providers participating 5 % Students currently working in salons: Yes 57% No 43% List of colleges & training organisations Beverley College, East Riding College, Goole College, Hessle High School, Hull College, Newland School for Girls, St Mary’s Walk, David Lister School, Freedom Centre, Oasis Academy, Prospect Training Results menu

15. Students Results: Feedback about DVD 1) Have you watched the DVD? Yes No 95% 5% 2) How useful did you find the following sections of the DVD? Maxine’s story Useful Not useful 70% 30% How to select, use, and remove disposable gloves Useful Not useful 80% 20% Looking after your hands (using moisturising creams & skin checks) Useful Not useful 81% 19% = Significant difference Results menu

16. Students Results: Feedback about DVD • 3) Has the DVD helped you to understand? • The causes of dermatitis in hairdressing work? • Yes Already aware No • 73% 26% 1% • How to prevent dermatitis? • Yes Already aware No • 80% 19.5% 0.5% • How to safely use non-latex gloves? • Yes Already aware No • 85% 13% 2% • How to protect your skin? • Yes Already aware No • 70% 29.5% 0.5% • How to check your skin for signs of damage? • Yes Already aware No • 76% 23.5% 0.5% = Significant difference Results menu

17. Students Results: Impact of guidance, information & training 5) Have you read the leaflet “Looking after your hands: wearing disposable gloves”? Yes No 56% 44% 6) Has your college given you a copy of the HABIA guidance booklet? Yes No 50% 50% 7) Has your employer explained to you how to prevent dermatitis? Yes No 79% 21% 8) Has your employer checked your hands for signs of dermatitis? Yes No 75% 25% = Significant difference Results menu

18. Students Results: Impact of guidance, information & training 9) Has your employer provided you with non-latex gloves for washing hair? Yes No 86% 14% 10) Has the leaflet helped you understand the advantages of using non latex disposable gloves? Yes Already aware No 87% 9% 4% = Significant difference Results menu

19. Teaching staff Results: Feedback about DVD Number of staff participating 23 Number of colleges participating 4 Number training organisations participating 1 Had the students that watched the DVD? Yes No 95% 5% For what activity was the DVD used Training students Training staff Other activity* 91% 17% 17% *Examples included:Informing employers; for group tutorials; for induction training Results menu

20. Teaching staff Results: Feedback about DVD 1) How would you rate the DVD for raising awareness to dermatitis & glove use? Yes No 92% 8% 2) How useful did you find the following sections of the DVD? Maxine’s story Useful Not useful 96% 4% How to select, use, and remove disposable gloves Useful Not useful 96% 4% Looking after your hands (using moisturising creams & skin checks) Useful Not useful 96% 4% = Significant difference Results menu

21. Teaching staff Results: Feedback about DVD • 3) Has the DVD helped you to understand? • The causes of dermatitis in hairdressing work? • Yes Already aware No • 79% 21% 0% • How to prevent dermatitis? • Yes Already aware No • 79% 21% 0% • How to safely use non-latex gloves? • Yes Already aware No • 79% 21% 0% • How to protect your skin? • Yes Already aware No • 75% 25% 0% • How to check your skin for signs of damage? • Yes Already aware No • 79% 21% 0% = Significant difference Results menu

22. Teaching staff Results: Impact of guidance, information & training 5) Have the students read the leaflet “Looking after your hands: wearing disposable gloves”? Yes No 86% 14% 6) Has the glove trial leaflet helped the students to understand the advantages of using non-latex gloves? Yes Already aware No 89% 11% 0% 7) Has your college obtained the HABIA Health & Safety Award? Yes No 84% 16% 8) Do you provide your students with a copy of the HABIA guidance booklet “Dermatitis and glove use for hairdressers”? Yes No 59% 41% = Significant difference Results menu

23. How useful did you find the DVD? Not No Useful Useful difference Hairdressing salon staff Students Teachers Overall result: Value of DVD to different groups Main menu

24. Conclusions: • The survey was very well supported with questionnaires completed by 252 hairdressing salons, 432 students and 23 teaching staff from training providers across East Riding of Yorkshire and Hull City Council • This survey demonstrated that a significant proportion (more than 75%) of the teaching staff and students considered that the DVD, glove trial leaflet and the HABIA guidance book had helped them to understand the causes and prevention of dermatitis • A significant proportion of the hairdressing salons (79%) said that the DVD had raised awareness about dermatitis and its causes and they would use it to train staff • The survey demonstrated that the DVD was valued most by trainers and students. Main menu

25. Conclusions: • Approximately 3 out of every 4 of the hairdressing salon staff said that they were already aware of the issues raised in the DVD and the guidance • Approximately 4 out of every 10 of the hairdressing salon staff said that they had used copies of the HABIA guidance Main menu

26. Conclusions: Examples of feedback Student comments about the DVD: “It was good, it helped me learn more about my hands and how to keep them healthy” “ After watching the DVD we tested ourselves with the gloves and learnt how to take them off properly” “Put more stories in about people with dermatitis” “Show more pictures of what can cause dermatitis” Hairdressing salon staff comments about the DVD: “Bit slow and patronising. Unrealistic scenarios for busy salon” “ Very informative” “Valuable for younger members of the team” “Need more info, clearly explaining dermatitis – a good introduction” “Longer length gloves not so easy to get hold of” Main menu

27. Acknowledgements We would like to thank the following for contributing to the evaluation of the guidance and DVD: • The hairdressing salon staff from Hull City and East Riding of Yorkshire. • The students and teaching staff from Beverley College, Hessle High School, Goole College, East Riding College, Hull College, St Mary’s Walk, David Lister College, Newland School for Girls, Prospect Training, Oasis Academy, Freedom Centre • Local authority colleagues from Hull City Council and East Riding of Yorkshire who carried out the surveys • Anton Gordon (VPS at HSL) for design of the presentation • Eileen Holmes (Mathematical Science Unit HSL) for carrying out the statistical analysis and Jo Bowen (CWH HSL) for supporting delivery of training events Main menu

28. Feedback from LA staff about using DVD for campaigns • Summary of feedback provided by survey respondents • 3) Previous LA Partnership work- HABIA Guidance • Questionnaires used in study • Questionnaires • 4) Materials distributed prior to survey • Dermatitis leaflet • Glove trial fact sheet • Dermatitis DVD (version for web sites) • HABIA guidance booklet • 5) Other resources • Looking after and checking your skin • Contamination of skin & taking off contaminated gloves • HSE posters • HSE website Information: Main menu

29. Solutions implemented to improve dialogue / contact Issues identified during evaluation exercise “Far too busy” to engage with LA Inspector • Letter explaining that salon will be inspected (including assessment of dermatitis controls) & that DVD will assist in preparing for the inspection Mail left un-opened in salon • Ring to make appointment reminding that DVD & information has been sent Salon had lost DVD / not received letter • Have extra copies available & ask salon to ring after receipt (follow up if no contact) • Make available portable DVD player-& encourage viewing as part of staff meeting to clarify salon rules Salon has no facility to watch DVD • Use questionnaire on visit to assess compliance & knowledge • Encourage discussion & refer to HSE skin check form Salon owner unsure of control measures to be implemented Background: Inspector’s suggestions encouraging use of DVD Annex menu

30. Background: Previous LA partnership work: HABIA guidance • The booklet summarises the following: • Five steps to healthy hands • What is dermatitis? • Signs and symptoms of dermatitis • What causes dermatitis? • Avoiding dermatitis – wearing gloves • Avoiding dermatitis – looking after your skin • Avoiding dermatitis – checking your skin • What does the law require? Annex menu

31. Background: Disposable glove trial • Previous studies have found that many hairdressers: • Used unsuitable disposable gloves (powdered latex) • Used chemicals that can damage the skin but without wearing gloves • Worked for long periods doing wet work without wearing gloves • Considered that disposable gloves were unsuitable for hairdressing work • Comments that were made before the trial was conducted “Gloves make it difficult to sense the temperature of the water” “Gloves are not comfortable to wear” “Gloves snag on the clients hair” “Gloves break easily” Annex menu

32. Background: Glove trial methodology • Laboratory tests of six different vinyl and nitrile disposable gloves included: • Touch and thermal sensitivity • Elasticity and durability (tear resistance) • Dexterity • Gloves were evaluated by an independent panel to assess: • Comfort and ease of fitting and removal • Consumable cost for replacing latex gloves Annex menu

33. Once hairdressers had tried disposable vinyl and nitrile gloves that fitted well, most of them were willing to use them • The hairdressers preferred longer length gloves that protected their wrists • The majority preferred the close fit of nitrile disposable gloves • After the trial most hairdressers were positive about using these gloves for wet work (hair washing) and handling chemicals (bleaches, perming solutions and colours) • Very few gloves (<1%) were found to have broken or torn during their use • What hairdressers said about the gloves they tried Background: Glove trial results Annex menu

34. Background: Glove trial results An opinion that did not change after the trial: Most hairdressers said that disposable gloves cannot be worn for cutting and styling hair Examples of changes of opinion after the trial concluded Annex menu

35. Background: Development of dermatitis DVD • A short educational DVD for Environmental Health Officers was produced • The DVD contains • A personal story of the impact of dermatitis • Instructions on selecting disposable gloves and their safe removal after use • Looking after your skin and checking your skin for damage • HSE Five steps to healthy hands Annex menu

36. Dermatitis is caused by exposure to physical, chemical and biological hazards that cause damage and provoke inflammation or allergy in the skin • Dermatitis typically occurs at the site of contact (e.g., hands) with the hazard but in more severe cases can spread to involve wider areas of the body (e.g., arms, neck, and face) • There are two major forms of occupational dermatitis (irritant and allergic dermatitis) • Whilst the agents that cause irritant ad allergic dermatitis may be different the symptoms for both conditions are often similar • Dermatitis symptoms may decline when exposure ceases but some types of dermatitis (e.g., allergic disease) persist and can be activated at a future time by exposure to small amounts of the hazard • Typical symptoms Background: What is dermatitis? Dry skin Itching Redness Swelling Flaking of skin Bleeding Blistering Cracking of skin Annex menu

37. Background: How does dermatitis occur? Annex menu

38. Background: What does dermatitis look like? Annex menu

39. A recent survey of the UK hairdressers found that 39% reported having had dermatitis on their hands at some point during their career • This compares to a prevalence of approximately 8% in the general adult population • More than two thirds of hairdressing apprentices suffer some form of skin damage, and a third experience more severe changes to their skin during their first few years in hairdressing work. Background: Prevalence of dermatitis amongst hairdressers Annex menu

40. Prolonged contact of the skin with water (called ‘wet work’) • Frequent contact with hazardous chemicals (particularly corrosive substances e.g., peroxides) • The duration and amount of exposure • For allergic dermatitis a family history of atopy (I.e, a predisposition to develop allergies to common environmental allergens e.g., pet dander, pollens, house dust mite) • Females and younger age groups are more at risk Background: Risk factors for dermatitis amongst hairdressers Annex menu

41. Irritants Lightening / bleaching agents Colorants Developers Removers Perm solutions Straightening products Neutralisers & relaxers Wet work & shampoos Background: Hazards causing dermatitis in hairdressing Allergens Persulphate salts (in bleaching agents) Paraphenylenediamine (PPD) in colorants Resorcinol in colorants Glyceryl thioglycolate / thioglycolate Salt (perms & straightening solutions) Perfumes Preservatives Nickel Latex in high protein content disposable gloves Annex menu

42. Background: Looking after skin • A layer of moisturiser will help protect skin and reduce the chance of drying • It is important to apply moisturiser after tasks like ‘wet work’ • Hand lotion need not be expensive, e.g. ‘own brand’ moisturising hand lotions containing emollient, liquid paraffin, glycerine can be equally effective • Products sold as barrier creams/protective creams/glovesin a bottle do not provide a genuine barrier against chemicals and water! Annex menu

43. Background: Checking skin • Checking for early signs of dermatitis • Who checks? • The employer • A responsible trained person delegated by the employer • The employee – once trained • What next if you see signs? • Investigate the work carried out • Check regularly to see if symptoms progress • Record your findings • Take action to protect skin and prevent further exposure Annex menu

44. Background: Removing contaminated gloves • When gloves become contaminated with chemicals (e.g., bleaches) it may not always be easy to see this • The photograph below uses a special dye to show how skin (e.g., finger tips) can become easily contaminated if you do not remove gloves properly • Follow this link for a chart that explains how to remove disposable gloves without contaminating skin. Or view the demonstration on the DVD. Annex menu

45. Background: Guidance on chemical hazards A more detailed list of ingredients found in salon hair products can be found in the booklet ‘A Guide To The Health & Safety of Salon Hair Products’ 8th Edition 2007 (written by the Cosmetic, Toiletry and Perfumery Association (CTPA). This guide to the health and safety requirements for salon products is available to order from the Hairdressing and Beauty Suppliers Association (cost: ~£1.00 plus postage; Tel: 01707 649499) Annex menu

46. Background: Guidance on skin disease • The HSE skin disease website contains a lot of very useful information, advice and case studies providing information for LA inspectors as well as employers, employees and trainees. This can be found by following the link: www.hse.gov.uk/skin Annex menu

47. This page links you to a website compatible video format of the DVD ‘Preventing Dermatitis: A guide for hairdressers’. Each section of the DVD can viewed by clicking the links below. • Introduction • About dermatitis in hair dressing • Dermatitis: a personal Story • Simple steps to protect your hands • Wearing gloves • Proper use of gloves • Proper glove removal • Looking after your hands • Summary Background: Link to DVD Annex menu Annex menu