Prevalence of skin and back diseases in geriatric care nurses

  • Madeleine Dulon
  • Kathrin Kromark
  • Christoph Skudlik
  • Albert Nienhaus
Original Article



The prevalence of hand eczema, low back disorders (LBD) and neck/shoulder disorders (NSD) in geriatric nurses and the association of work-related factors with hand eczema, LBD and NSD in geriatric nurses were examined.


The cross-sectional study comprises 1,390 nurses and nursing aides. Nurses underwent clinical examinations of their hands and their back and answered a questionnaire. Odds ratios (ORs) and 95% confidence intervals (95% CI) for putative risk factors were calculated by logistic regression.


The point prevalence of hand eczema was 18.0%. Disposing factors, like atopic eczema in childhood and dry or itching body skin, were statistically significant risk factors for irritant skin changes. Hand cleaning and hand care were not predictive for hand eczema. LBD was observed in 47.9% and NSD in 16.6% of the nurses. Increasing age and years in the nursing profession, prior treatment of back disorder and psychological stress were significant risk factors for LBD and NSD.


Hand eczema and LBD or NSD are often found in geriatric nurses. Therefore, workplace-related health promotion should be improved for geriatric nurses.


Contact dermatitis Low back pain Occupational diseases Nurses Geriatric nursing 



We are grateful to the occupational physicians who performed the orthopedic and dermatological examinations and to all the geriatric nurses who participated in our study. We thank Dr. Soyka for his orthopedic advices and Dr. Pohrt for her effort in training the occupational physicians.


  1. Ando S, Ono Y, Shimaoka M et al (2000) Associations of self estimated workloads with musculoskeletal symptoms among hospital nurses. Occup Environ Med 57:211–216PubMedCrossRefGoogle Scholar
  2. Bauer A, Bartsch R, Hersmann C et al (2001) Occupational hand dermatitis in food industry apprentices: results of a 3-year follow-up cohort study. Int Arch Occup Environ Health 74:437–442PubMedCrossRefGoogle Scholar
  3. Berndt U, Hinnen U, Iliev D, Elsner P (1999) Role of the atopy score and of single atopic features as risk factors for the development of hand eczema in trainee metal workers. Br J Dermatol 140:922–924PubMedCrossRefGoogle Scholar
  4. Berndt U, Hinnen U, Iliev D, Elsner P (2000) Hand eczema in metalworker trainees-an analysis of risk factors. Contact Derm 43:327–332PubMedCrossRefGoogle Scholar
  5. Blinkert B, Klie T (2001) Zukünftige Entwicklung des Verhältnisses von professioneller und häuslicher Pflege bei differierenden Arrangements und privaten Ressourcen bis zum Jahr 2050. Expertise im Auftrag der Enqéte-Kommission Demographischer Wandel des Deutschen Bundestages. Berlin/FreiburgGoogle Scholar
  6. Burton AK, Symonds TL, Zinzen E et al (1997) Is ergonomic intervention alone sufficient to limit musculoskeletal problems in nurses? Occup Med (Lond) 47:25–32CrossRefGoogle Scholar
  7. Burton K, Waddell G (2004) Risk factors for back pain. In: The back pain revolution. Churchill Livingstone, pp 91–113Google Scholar
  8. Byrns G, Reeder G, Jin G, Pachis K (2004) Risk factors for work-related low back pain in registered nurses, and potential obstacles in using mechanical lifting devices. J Occup Environ Hyg 1:11–21PubMedCrossRefGoogle Scholar
  9. Coenraads PJ, Van Der Walle H, Thestrup-Pedersen K et al (2005) Construction and validation of a photographic guide for assessing severity of chronic hand dermatitis. Br J Dermatol 152:296–301PubMedCrossRefGoogle Scholar
  10. Diepgen TL, Schmidt A (2002) Werden Inzidenz und Prävalenz berufsbedingter Hauterkrankungen unterschätzt? Arbeitsmed Sozialmed Umweltmed 37:477–480Google Scholar
  11. Grifka J, Tingart M, Hofbauer R, Peters T (2002) Development and trial use of multistep diagnosis of musculoskeletal disorders during a routine physical examination at the workplace. Orthopade 31:973–980PubMedCrossRefGoogle Scholar
  12. Held E, Skoet R, Johansen JD, Agner T (2005) The hand eczema severity index (HECSI): a scoring system for clinical assessment of hand eczema. A study of inter- and intraobserver reliability. Br J Dermatol 152:302–307PubMedCrossRefGoogle Scholar
  13. Jungbauer FH, Steenstra FB, Groothoff JW, Coenraads PJ (2005) Characteristics of wet work in nurses. Int Arch Occup Environ Health 78:248–251PubMedCrossRefGoogle Scholar
  14. Knibbe JJ, Friele RD (1996) Prevalence of back pain and characteristics of the physical workload of community nurses. Ergonomics 39:186–198PubMedCrossRefGoogle Scholar
  15. Lagerström M, Hansson T, Hagberg M (1998) Work-related low-back problems in nursing. Scand J Work Environ Health 24:449–464PubMedGoogle Scholar
  16. Larson E, Friedman C, Cohran J, Treston-Aurand J, Green S (1997) Prevalence and correlates of skin damage on the hands of nurses. Heart Lung 26:404–412PubMedCrossRefGoogle Scholar
  17. Leboeuf-Yde C (2000) Body weight and low back pain. A systematic literature review of 56 journal articles reporting on 65 epidemiologic studies. Spine 25:226–237PubMedCrossRefGoogle Scholar
  18. Lipscomb J, Trinkoff A, Brady B, Geiger-Brown J (2004) Health care system changes and reported musculoskeletal disorders among registered nurses. Am J Public Health 94:1431–1435PubMedGoogle Scholar
  19. Löffler H, Dickel H, Bruckner T, Effendy I, Happle R (2002) Skin changes in geriatric nurses prior to training heralding a particular risk of hand dermatitis. Eur J Dermatol 12:452–454PubMedGoogle Scholar
  20. Lundberg G, Gerdle B (2000) Correlations between joint and spinal mobility, spinal sagittal configuration, segmental mobility, segmental pain, symptoms and disabilities in female homecare personnel. Scand J Rehabil Med 32:124–133PubMedCrossRefGoogle Scholar
  21. Mahler V (2007) Skin protection in the healthcare setting. Curr Probl Dermatol 34:120–132PubMedCrossRefGoogle Scholar
  22. Meding B (2000) Differences between the sexes with regard to work-related skin disease. Contact Derm 43:65–71PubMedCrossRefGoogle Scholar
  23. Nienhaus A (2005) Gefährdungsprofile - Unfälle und arbeitsbedingte Erkrankungen in Gesundheitsdienst und Wohlfahrtspflege. ecomed Medizin, Landsberg/Lech, pp 14–34Google Scholar
  24. Simon M, Tackenberg P, Nienhaus A et al (2007) Back or neck-pain-related disability of nursing staff in hospitals, nursing homes and home care in seven countries-results from the European NEXT-Study. Int J Nurs Stud doi: 10.1016/j.ijnurstu.2006.11.003
  25. Skudlik C, Dulon M, Pohrt U et al (2006) Osnabrueck hand eczema severity index—a study of the interobserver reliability of a scoring system assessing skin diseases of the hands. Contact Derm 55:42–47PubMedCrossRefGoogle Scholar
  26. Smedley J, Inskip H, Trevelyan F et al (2003) Risk factors for incident neck and shoulder pain in hospital nurses. Occup Environ Med 60:864–869PubMedCrossRefGoogle Scholar
  27. Smit HA, Burdorf A, Coenraads PJ (1993) Prevalence of hand dermatitis in different occupations. Int J Epidemiol 22:288–293PubMedCrossRefGoogle Scholar
  28. Smith DR, Mihashi M, Adachi Y, Koga H, Ishitake T (2006) A detailed analysis of musculoskeletal disorder risk factors among Japanese nurses. J Safety Res 37:195–200PubMedCrossRefGoogle Scholar
  29. Statistisches Bundesamt (2007) Pflegestatistik 2005 - Pflege im Rahmen der Pflegeversicherung Deutschlandergebnisse. Statistisches Bundesamt, Gruppe Soziales, WiesbadenGoogle Scholar
  30. Stingeni L, Lapomarda V, Lisi P (1995) Occupational hand dermatitis in hospital environments. Contact Derm 33:172–176PubMedCrossRefGoogle Scholar
  31. Stubbs DA, Buckle PW, Hudson MP, Rivers PM (1983) Back pain in the nursing profession II. The effectiveness of training. Ergonomics 26:767–779PubMedCrossRefGoogle Scholar
  32. Tingart M, Lerch K, Hofbauer R, Grifka J (2003) Prinzipien der Mehr-Stufen-Diagnostik: Ein Instrumentarium zur Diagnose von Muskel-Skelett-Erkrankungen. Arbeitsmed Sozialmed Umweltmed 38:6–10Google Scholar
  33. Trinkoff AM, Brady B, Nielsen K (2003) Workplace prevention and musculoskeletal injuries in nurses. J Nurs Adm 33:153–158PubMedCrossRefGoogle Scholar
  34. Uter W, Pfahlberg A, Gefeller O, Schwanitz HJ (1999a) Hand dermatitis in a prospectively-followed cohort of hairdressing apprentices: final results of the POSH study. Prevention of occupational skin disease in hairdressers. Contact Derm 41:280–286PubMedCrossRefGoogle Scholar
  35. Uter W, Schwanitz HJ, Pfahlberg A, Gefeller O (1999b) Zur Validierung des “Atopie-Score” anhand einer berufsdermatologischen Studienkohorte. Allergo J 8:294–296Google Scholar
  36. Yip YB (2001) A study of work stress, patient handling activities and the risk of low back pain among nurses in Hong Kong. J Adv Nurs 36:794–804PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Madeleine Dulon
    • 1
  • Kathrin Kromark
    • 1
  • Christoph Skudlik
    • 2
  • Albert Nienhaus
    • 1
  1. 1.Institution of Statutory Accident Insurance of the Health and Welfare ServiceHamburgGermany
  2. 2.Department Dermatology, Environmental Medicine, Health Theory, Faculty of Human ScienceUniversity of OsnabrückOsnabrückGermany

Personalised recommendations