| dc.description.abstract | Background: Nursing students are required to complete a minimum of 2000 practical hours in healthcare facilities during their four years of tertiary education. They are required to frequently wash and disinfect their hands during a practical shift to prevent nosocomial infections in patients. These routines involving frequent hand washing in combination with skin occlusion from wearing latex or nitrile gloves may have a negative impact on the skin condition of their hands. Transepidermal water loss (TEWL), stratum corneum (SC) hydration and skin surface pH are common parameters included in assessing the effect of frequent hand washing and wet work on skin condition. However, limited published literature exists on the long-term effects of nursing student practical training on skin barrier function and how skin barrier function compares between White and Black African nursing students. International studies have focused on investigating hand dermatitis as a consequence of these workplace conditions in nursing students, however prevalence and severity of hand dermatitis have not been investigated among a South African nursing student population. Natural moisturising factor (NMF) has been used recently to establish the risk of developing skin diseases such as dermatitis associated with low NMF. Quantifying NMF in a nursing student population may provide valuable insight into their potential susceptibility for skin conditions associated with low NMF. Evaluating skin barrier function in nursing students provides the opportunity to not only investigate early changes in these biophysical parameters, during their practical training, but may also provide the means to identify early interventions that may protect their skin health already at the start of their career.
Aims and objectives: The aim of this thesis was to quantify and compare skin barrier function, NMF content and hand dermatitis prevalence and severity between South African White and Black African nursing students during their tertiary education. The specific objectives were (i) to compare baseline skin barrier function between White and Black African nursing students, (ii) to compare NMF content of the skin on the hands between White and Black African nursing students, (iii) to evaluate the skin barrier function of White and Black African nursing students during the progression of their tertiary education and (iv) to quantify hand dermatitis prevalence and severity among tertiary nursing students.
Methods: Skin barrier function parameters including TEWL, SC hydration and skin surface pH were measured in female nursing students (63 White, 42 Black African) three times a year and repeated for two years, before the COVID-19 pandemic. Baseline skin barrier function was established by measuring TEWL, SC hydration and skin surface pH in first-year White and Black African nursing students prior to the commencement of their practical training. Skin barrier function parameters were measured on the dorsal aspects and palms of both hands and additionally on both volar forearms. Tape strip samples were collected from participants’ dominant dorsal hands and NMF content was measured, including histidine (HIS), pyrrolidone carboxylic acid (PCA), trans-urocanic acid (t-UCA) and cis-urocanic acid (c-UCA), as well as cytokines interleukin-1 α (IL-1α) and interleukin-1 receptor antagonist (IL-1RA). NMF components HIS, PCA, t-UCA, c-UCA and total NMF (tot-NMF which is the sum of individual components) were determined by High Performance Liquid Chromatography after extraction with water. A dermatologist clinically evaluated the skin of the participants to diagnose the prevalence and severity of dermatitis among the participants. The presence of erythema, oedema, oozing/crusts, excoriation, lichenification and dryness of the affected skin area were evaluated and a severity score (None = 0; Mild = 1; Moderate = 2; Severe = 3) was designated for each of the six clinical signs (Maximum score = 18). These evaluations were performed at the start of the South African academic year (January) and at the end of the year (November) to assess any change in dermatitis severity.
Results: No significant difference in TEWL was established between the White and Black African nursing students. SC hydration was significantly lower (p ≤ 0.05), and skin surface pH was significantly higher (p ≤ 0.0001) in Black African nursing students when compared to White students. No statistically significant differences in PCA, t-UCA, c-UCA, IL-1α or IL-1RA were found between Black African and White nursing students. HIS was significantly (p = 0.001) higher in White nursing students when compared to Black African students. The ratio of tot-UCA/HIS was significantly higher in Black Africans (p = 0.0002), while the ratio of c-UCA/tot-UCA was significantly (p = 0.0001) lower when compared to White nursing students. TEWL and SC hydration significantly (p < 0.001) decreased over two years in the first-year students, while only specific differences were established for senior students. Skin surface pH varied significantly (p < 0.001) over the two years with significant increases (p < 0.031) in the winter months. The only significant difference between White and Black African students was established in skin surface pH, where Black African students had significantly higher (p < 0.001) skin surface pH on the dorsal hands. Hand dermatitis prevalence increased with 11% for White and 12% for Black African nursing students after one year of training. Hand dermatitis scores increased significantly (p < 0.04) between the start and end of one year of practical training in both racial groups. Black African nursing students had the highest severity index of 6 at the end of one year of practical training.
Conclusions: Black African nursing students had significantly lower baseline SC hydration and higher baseline skin surface pH. Whereas skin barrier function trends over a period of two years and NMF content did not differ significantly between the racial groups, Black African nursing students still had higher hand dermatitis prevalence and severity scores after one year of practical training. The impact of nursing student practical training on skin health was demonstrated among a South African nursing student population, providing valuable and novel findings for a high-risk population of nursing students. | en_US |
