Occupational skin health risk among nurses: development and validation of a nomogram-based prediction model

Occupational contact dermatitis (OCD) is a prevalent work-related skin condition among nurses and remains a significant occupational health issue due to its impact on well-being, productivity, and workforce sustainability. However, reliable tools for early risk stratification in this population are lacking. This study aimed to develop and validate a nomogram-based prediction model to estimate the individual risk of OCD among nurses.

A multicenter cross-sectional survey was conducted among 2,852 nurses from 40 hospitals across China. Participants were randomly assigned to a training cohort (n = 2,000) and a validation cohort (n = 852). Independent predictors were identified using univariate and multivariable logistic regression analyses. A nomogram was constructed based on the final multivariable model. Model performance was assessed using the area under the ROC curve (AUC), bootstrapped calibration plots, and decision curve analysis (DCA).

Nine predictors were independently associated with OCD: age, dermatitis history, glove type, glove-wearing hours, handwashing frequency during work, hospital level, hand-cream habit, baseline skin condition, and sleep duration. The model showed excellent discrimination (AUC = 0.925 in the training set; 0.931 in the validation set). Calibration curves demonstrated close agreement between predicted and observed risks. DCA indicated consistently higher net benefit compared with the "treat-all" and "treat-none" strategies across wide threshold probability ranges (0.01-0.98 in the training set; 0.02-0.96 in the validation set). The resulting nomogram provides an intuitive, point-based tool for individualized OCD risk prediction.

A robust, well-validated prediction model and nomogram were developed to estimate OCD risk among nurses. This tool may support occupational health screening, early risk identification, and targeted preventive strategies in healthcare institutions.