Pressure Injuries Due to Personal Protective Equipment in COVID-19 Critical Care Units

Abstract

Background Caring for patients with COVID-19 requires wearing a full set of personal protective equipment (PPE) to avoid contamination. Personal discomfort has been associated with use of PPE, and anecdotal reports describe pressure injuries related to wearing PPE. Objectives To investigate the occurrence of device-related pressure injuries due to wearing PPE among Italian nurses caring for patients with COVID-19 in critical care settings. Methods This descriptive study used an online survey investigating both the demographic characteristics of respondents and complications related to wearing PPE, including the development of pressure injuries. Results A total of 266 nurses throughout Italy completed the survey; 32% of respondents were men. Nurses’ median age was 36 years (range 22-59 years), and the median time spent working in their current clinical setting (an intensive care or high-dependency unit) was 3 years (range 0-32 years). Personal protective equipment was worn for a median duration of 5 hours (range 2-12 hours). While wearing PPE, 92.8% of nurses experienced pain and 77.1% developed device-related pressure injuries, mainly on the nose and forehead. Pain was more frequent among nurses with such injuries. Transparent dressings, emollient cream, and no dressing were associated with development of device-related pressure injury. Conclusions Pressure injuries related to PPE represent an important adverse effect for nurses caring for patients with COVID-19. This topic deserves study to determine adequate solutions for preventing and treating such injuries and their potential influence on nurses’ work tolerance.

Feasibility of nasal bridge pressure injury prevention using a protective dressing and the Halyard Fluidshield® N95 mask in a COVID‐positive environment

“…The NPIAP acknowledged the need for prophylactic measures to mitigate pressure injuries secondary to PPE use. 20 However, they also reported the uncertainty of utilising dressings under PPE due to the risk of seal integrity. 21 Therefore, our study protocol included standardised fit testing, before and after, application of the tested dressings, as a secondary aim and additional safety element.…”

“…As the pandemic evolved and higher incidence of facial skin injury was noted with long‐term PPE wear. The NPIAP acknowledged the need for prophylactic measures to mitigate pressure injuries secondary to PPE use 20 . However, they also reported the uncertainty of utilising dressings under PPE due to the risk of seal integrity 21 .…”

Efeitos adversos relacionados ao uso de máscaras faciais durante a pandemia da COVID-19: Revisão Integrativa

“…A prevalência de lesão por pressão foi bastante elevada entre os médicos (59,2%), porém inferior a outros estudos recentes. (Coelho et al, 2020;Bambi et al, 2021). observou-se que os indivíduos que utilizaram a máscara N95 em associação aos óculos de proteção e apresentaram sudorese tiveram um risco muito elevado de desenvolver lesões.…”

The prevalence of facial pressure injuries among nurses during COVID-19 pandemic and its relationship to COVID-19 infection

“…According to Bambi et al, PPE-related FPI developed in 77.1% of nurses who worked in intensive care in the COVID-19 pandemic period [ 14 ]. The results of our study revealed the risk of FPI development in the participants who worked in intensive care to be 1.8 times as high as the risk of others.…”

“…Previous studies have reported that the prolonged use of PPE may result in various dermatoses, including the exacerbation of previously existing skin disorders such as facial pressure injuries (FPI), contact dermatitis, pressure urticaria, seborrheic dermatitis, and acne [ 4 , 11 , 13 ]. It has been frequently observed that especially in healthcare workers, pressure injuries develop in the face after the prolonged use of facemasks and face-protective equipment [ 14 ]. When PPE is used, especially throughout an entire working shift that can last as long as 12 h, it will create constant pressure, friction, and abrasion on the skin it has contact with.…”