Some 42.8 percent of medical staff treating patients with COVID-19 have experienced serious skin injury due to the use of personal protective equipment (PPE) such as goggles, masks, face shields and protective gowns, according to a study published in Advances in Wound Care. The research found that injuries put providers at an increased risk of infection, with inadequate prevention and treatment measures in place.
What did the study find?
The study was authored by a team of clinicians, including Qixia Jiang, MSN, RN, ET, of the Nanjing University School of Medicine in Nanjing, China. The researchers identified three main types of PPE-related injuries: skin tear, device-related pressure injuries and moisture-associated skin damage. Factors such as heavy sweating, being male, greater daily wearing time and using grade 3 versus grade 2 PPE increased the risk for skin injury.
The study showed that fewer than one fifth of the respondents used prophylactic dressings and lotions to treat their skin. According to the research team, this may be for several reasons:
- Medical staff tended to ignore skin protection at the early stage.
- Those on the front lines didn’t get training on how to prevent and treat skin injuries.
- Some providers worried that if they used dressings to protect themselves, their masks and goggles wouldn’t close enough and could increase their infection risk.
In addition, the study authors wrote, “relevant preventive resources in response to public health emergencies were inadequate, and so medical staff used what was available.”
In an email interview with Florence Health, Jiang said PPE-caused skin injuries in medical staff could be prevented.
“The skin injuries we investigated occurred in the early days of the fight against the epidemic, when we did not realize the problem,” she wrote. “We immediately adopted strategies to guide medical staff to use foam dressings to prevent and treat these early. After a month, the medical staff reported a significant decrease in the incidence of skin injuries.”
Jiang and her team found that the skin injuries caused by grade 3 PPE (worn to protect staff who are in close contact with COVID-19 patients in, for example, the ICU or in isolation wards and thus are at higher risk of infection) were significantly worse than those caused by grade 2 PPE (worn to protect staff with moderate risk exposure).
Grade 3 PPE – which includes N95/KN95 respirators with goggles or face masks, protective gowns and latex gloves – is thick, heavy and can easily cause perspiration, Jiang says.
What can providers do?
Michele S. Green, MD, a dermatologist at Lenox Hill Hospital in New York City, says medical staff can use topical emollients and cortisone creams, as well as antibiotic ointments like Bactroban, to help heal PPE-caused skin injuries,
“Silvadene cream, which is a burn cream, is very effective as well to help these sounds heal more quickly,” Green tells Florence Health.
Should medical staff alternate types of PPE to reduce their injury risk?
“It’s difficult for staff to use alternate types of PPE,” Green says. “But if someone is doing more ‘charting’ or paperwork, they could wear a less restrictive mask and not the N95 mask for those times. Since gloves can be very irritating to some, there can be times when hand-washing could replace chronic glove use.”
Asked if there are any alternative PPE that health care providers could use, Jiang wrote: “At present, no alternative PPE has been found, but Chinese researchers are improving the material and shape of protective equipment.”