- Amongst first-line healthcare workers, 97% reported skin damage caused by enhanced infection-prevention measures, the nasal bridge being the most damaged site (83.1%)1
- Dryness/tightness was the most frequent symptom (70.3%), and desquamation the most common sign (61.6%)1
- Wearing some medical devices for > 6 hours increased skin damage risks(face shields being an exception)1
- Skin damage on cheeks, nasal bridge and forehead were respectively related to N95 mask, goggle and face shield1
- Hand skin damage, like eczema, was seen with frequent hand hygiene and longer glove wear1
- Skin damage could affect workers’ moral and cause anxiety1
- In terms of preventing pressure injuries, spraying a barrier film before device wear and applying omental lipids cream/emulsion and non-adherent dressings after device wear were recommended. To prevent scar/hyperpigmentation, silicone cream/sheet and SPF 50+ cream/spray/emulsion were suggested after device removal4
- Prophylactic hydrocolloid dressings could in theory reduce risk of pressure-related skin injuries2
- Plastic handle can be used with earloop N-95 mask to reduce discomfort and ear skin injury as well as increase airtightness. The handle is also reusable after disinfection3
- For grade 1 injuries, barrier film (spray/sheet) and non-adherent dressings were recommended after device wear4
- Saline solution and Polyhexamethylene biguanide (PHMB) were recommended in cleansing grade 2/3 pressure injuries4
- For grade 2/3 injuries, extra thin hydrocolloid dressings and thin polyurethane silicone foam were recommended after device removal4
Points #1-6 came from a study by Lan J. et al that included the answers of 542 physicians or nurses working in departments of tertiary hospitals in Hubei, China, to an online questionnaire concerning type of skin damages, and frequency/duration of multiple infection-prevention measures. Limitations to the study included looking at one site with one exposure factor (whilst it could be multifactorial) and excluding other risk factors to skin damage outside hospital work. Point #8 came from a study by Bishopp A. et al in which hydrocolloid dressings were placed over nasal bridges of patients needing non-invasive ventilation between October 30th2015 and October 29th2016. The rates of nasal bridge pressure injuries were then assessed and compared. Further studies would be needed to make sure these dressings do not alter efficacy of safety devices.
Point #9 came from a study by Jiang W. et al that tested the efficacy of plastic handles as a solution to prevent pressure injury on ear skin with prolonged use of earloop-style N-95 masks (which could put workers at risk of infection).
Points #7, 10-12 came from a review (by Oranges T. et al) of the article “Skin damage among healthcare workers managing coronavirus disease-2019”1and offers methods in managing medical device-induced pressure injuries.
Sources:
- Lan J, Song Z, Miao X, Li H, Li Y, Dong L, Yang J, An X, Zhang Y, Yang L, Zhou N, Yang L, Li J, Cao J, Wang J, Tao J, Skin damage among healthcare workers managing coronavirus disease-2019, Journal of the American Academy of Dermatology (2020), doi: https:// doi.org/10.1016/j.jaad.2020.03.014.
- Bishopp, A., Oakes, A., Watson, A., Chakraborty, B., Stygall, G., Antoine-Pitterson, P., … Mukherjee, R. (January 22nd, 2019). The preventive effect of hydrocolloid dressings on nasal bridge pressure ulceration in acute non-invasive ventilation. Ulster Med J. 88(1): 17–20
- Jiang W, Cao W, Liu Q, Wear N95 Mask With Plastic Handle Reduce Pressure Injury, Journal of the American Academy of Dermatology (2020), doi: https://doi.org/10.1016/ j.jaad.2020.04.001.
- Oranges T, Janowska A, Dini V, Reply to: “Skin damage among healthcare workers managing coronavirus disease-2019”, Journal of the American Academy of Dermatology (2020), doi: https://doi.org/10.1016/j.jaad.2020.04.003.