Open Access Study protocol

Hands4U: A multifaceted strategy to implement guideline-based recommendations to prevent hand eczema in health care workers: design of a randomised controlled trial and (cost) effectiveness evaluation

Esther WC van der Meer1, Cécile RL Boot12*, Frank HW Jungbauer3, Jac JL van der Klink3, Thomas Rustemeyer4, Pieter Jan Coenraads5, Joost W van der Gulden6 and Johannes R Anema127

Author Affiliations

1 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands

2 Body@Work, Research Center Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, the Netherlands

3 Department of Public and Occupational Health, Groningen University Medical Center, the Netherlands

4 Department of Dermatology, VU University Medical Center, Amsterdam, the Netherlands

5 Dermatology Department, University Medical Center Groningen, University of Groningen, the Netherlands

6 Department of Primary and Community Care, Centre for Family Medicine, Geriatric care and Public Health, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands

7 Research Center for Insurance Medicine AMC-UWV-VU University Medical Center, Amsterdam, the Netherlands

For all author emails, please log on.

BMC Public Health 2011, 11:669  doi:10.1186/1471-2458-11-669

Published: 25 August 2011



Workers in wet work occupations have a risk for developing hand eczema. Prevention strategies exist, but compliance to the proposed recommendations is poor. Therefore, a multifaceted implementation strategy (MIS) is developed to implement these recommendations to reduce hand eczema among health care workers performing wet work.


This study is a randomised controlled trial in three university hospitals in the Netherlands. Randomisation to the control or intervention group is performed at department level. The control group receives a leaflet containing the recommendations only. The intervention group receives the MIS which consists of five parts: 1) within a department, a participatory working group is formed to identify problems with the implementation of the recommendations, to find solutions for it and implement these solutions; 2) role models will help their colleagues in performing the desired behaviour; 3) education to all workers will enhance knowledge about (the prevention of) hand eczema; 4) reminders will be placed at the department reminding workers to use the recommendations; 5) workers receive the same leaflet as the control group containing the recommendations. Data are collected by questionnaires at baseline and after 3, 6, 9 and 12 months. The primary outcome measure is self-reported hand eczema. The most important secondary outcome measures are symptoms of hand eczema; actual use of the recommendations; sick leave; work productivity; and health care costs.

Analyses will be performed according to the intention to treat principle. Cost-effectiveness of the MIS will be evaluated from both the societal and the employer's perspective.


The prevention of hand eczema is important for the hospital environment. If the MIS has proven to be effective, a major improvement in the health of health care workers can be obtained. Results are expected in 2014.

Trial registration number