Personal protective equipment related skin reactions in healthcare professionals during COVID‐19

Abstract

Since the outbreak of COVID‐19 pandemic, clinicians have had to use personal protective equipment (PPE) for prolonged periods. This has been associated with detrimental effects, especially in relation to the skin health. The present study describes a comprehensive survey of healthcare workers (HCWs) to describe their experiences using PPE in managing COVID‐19 patients, with a particular focus on adverse skin reactions. A 24‐hour prevalence study and multi‐centre prospective survey were designed to capture the impact of PPE on skin health of hospital staff. Questionnaires incorporated demographics of participants, PPE type, usage time, and removal frequency. Participants reported the nature and location of any corresponding adverse skin reactions. The prevalence study included all staff in intensive care from a single centre, while the prospective study used a convenience sample of staff from three acute care providers in the United Kingdom. A total of 108 staff were recruited into the prevalence study, while 307 HCWs from a variety of professional backgrounds and demographics participated in the prospective study. Various skin adverse reactions were reported for the prevalence study, with the bridge of the nose (69%) and ears (30%) being the most affected. Of the six adverse skin reactions recorded for the prospective study, the most common were redness blanching (33%), itchiness (22%), and pressure damage (12%). These occurred predominantly at the bridge of the nose and the ears. There were significant associations ( P < .05) between the adverse skin reactions with both the average daily time of PPE usage and the frequency of PPE relief. The comprehensive study revealed that the use of PPE leads to an array of skin reactions at various facial locations of HCWs. Improvements in guidelines are required for PPE usage to protect skin health. In addition, modifications to PPE designs are required to accommodate a range of face shapes and appropriate materials to improve device safety.

Adverse Effects of Personal Protective Equipment Among Intensive Care Unit Healthcare Professionals During the COVID-19 Pandemic: A Scoping Review

“…The flow diagram is presented in Online Appendix 3. We included 12 cross-sectional studies (Bharatendu et al., 2020; Çağlar et al., 2020 ; Hajjij et al., 2020 ; Heider et al., 2021 ; Jiang, Liu, et al., 2020 ; Jiang, Song, et al., 2020 ; Ong et al., 2020 ; Ramanan et al., 2020 ; Swaminathan et al., 2020 ; Tabah et al., 2020; Unoki et al., 2020; Xia et al., 2020 ), three case reports ( Chiriac et al., 2020 ; Dell’Era et al., 2020 ; Lam et al., 2020 ), three reviews ( Downie, 2020 ; Gefen & Ousey, 2020 ; Gross et al., 2021 ), including a systematic review, two observational studies ( Abiakam et al., 2021 ; Choudhury et al., 2020 ) including a study combined with a point prevalence study, a retrospective study ( He et al., 2020 ), two qualitative studies ( Begerow et al., 2020 ; Hoernke et al., 2021 ), and two letters without cases or data ( Goh et al., 2020 ; Wiwanitkit, 2020 ). Participants of seven studies were exclusively HCWs working in the ICUs; however, participants of the remaining studies included HCWs working in the ICU.…”

“…Five articles investigated specific symptoms, such as PPE-related headaches (Bharatendu et al., 2020; Goh et al., 2020 ; Hajjij et al., 2020 ; Ong et al., 2020 ) and voice disorders ( Heider et al., 2021 ). Nine studies reported PPE-related skin injuries and manifestations ( Abiakam et al., 2021 ; Chiriac et al., 2020 ; Dell’Era et al., 2020 ; Downie, 2020 ; Gefen & Ousey, 2020 ; Jiang, Liu, et al., 2020 ; Jiang, Song, et al., 2020 ; Lam et al., 2020 ; Wiwanitkit, 2020 ). After conceptual classification, we concluded that the studies covered four key topics: PPE-related headaches, voice disorders, and skin injuries and/or manifestations, and miscellaneous AEs of PPE.…”

“…Nine articles ( Abiakam et al., 2021 ; Chiriac et al., 2020 ; Dell’Era et al., 2020 ; Downie, 2020 ; Gefen & Ousey, 2020 ; Jiang, Liu, et al., 2020 ; Jiang, Song, et al., 2020 ; Lam et al., 2020 ; Wiwanitkit, 2020 ) described PPE-related skin injury manifestations; however, these consisted of three original articles ( Abiakam et al., 2021 ; Jiang, Liu, et al., 2020 ; Jiang, Song, et al., 2020 ), three case studies ( Chiriac et al., 2020 ; Dell’Era et al., 2020 ; Lam et al., 2020 ), a letter without data or cases ( Wiwanitkit, 2020 ), and two brief reviews ( Downie, 2020 ; Gefen & Ousey, 2020 ). All the studies and opinions focused on the use of masks.…”

“…Injuries were frequently observed at the bridge of the nose, cheeks, and ears (Jiang, Song et al, 2020). A one point prevalence study conducted with 108 HCWs working in an ICU and a high dependency unit revealed that the skin around the bridge of the nose (69%), ears (30%), cheeks (23%), and chin (20%) was affected, resulting in redness blanching, pressure damage, and itching (Abiakam et al, 2021). Lam et al (2020) reported five HCWs working in ICUs with pressure ulcers at the bridge of the nose within two-week periods.…”

A Personal Respirator to Improve Protection for Healthcare Workers Treating COVID-19 (PeRSo)

“…Filtering facepiece respirator masks are designed to protect HCWs from infection whilst treating patients, as distinct from surgical masks which are intended to protect others from the wearer (9). Reported limitations of N95/FFP3 masks include interface pressure between the mask and face, thermal discomfort and skin tissue injury after long-term use, impairment to breathing, failure of the face-mask seal whilst talking and recurrent fit testing failure for certain face shapes, effectively removing ∼5% of the workforce (10)(11)(12)(13). The standard that defines FFR efficiency allows 5% inward leakage maximum, and 1% aerosol filter penetration by 0.02-2 µm (median 0.6 µm) particles (14).…”