Preventing Facial Pressure Injury for Health Care Providers Adhering to COVID-19 Personal Protective Equipment Requirements

Abstract

OBJECTIVE: To determine if a repurposed silicone-based dressing used underneath a N95 mask is a safe and beneficial option for facial skin injury prevention without compromising the mask's seal. METHODS: Since February 21, 2020, staff in high risk areas such as the ED and ICU of King Hamad University Hospital have worn N95 masks when doing aerosol-generating procedures to protect against the novel coronavirus 2019. At that time, without education enablers or resources that could be directly translated into practice, the hospital's Pressure Injury Prevention Committee explored and created a stepwise process to protect the skin under these masks. This procedure was developed over time and tested to make sure that it did not interfere with the effectiveness of the N95 mask seal. RESULTS: Skin protection was achieved by repurposing a readily available silicone border dressing cut into strips. This was tested on 10 volunteer staff members of various skin types and both sexes who became part of this evidence generation project. Oxygen saturation values taken before and after the 4-hour wear test confirmed that well-fitted facial protection did not compromise the mask seal, but rather improved it. An added advantage was increased comfort with less friction as self-reported by the staff. An educational enabler to prevent MDRPI from N95 mask wear was an important additional resource for the staff. CONCLUSIONS: This creative and novel stepwise process of developing a safe skin protection method by which staff could apply a repurposed silicone border dressing beneath an N95 mask was largely effective and aided by the creation of the enabler.

Determination of the effect of prophylactic dressing on the prevention of skin injuries associated with personal protective equipments in health care workers during COVID-19 pandemic

“…In the present study, fogging in goggle, fogging in face shield, perspiration and moisture on the face are problems experienced by almost all participants irrespective of their group. Similar problems were observed in other studies as well [16,31]. However, discomfort in breathing was experienced in all participants except one in groups CG and EG1, while in EG2, which used Breathe Right®, none of the participants experienced this problem (n = 8).…”

“…Finally, excessive sweating and accumulating moisture on the facial skin due to work stress caused by heavy work load and working with PPE leads the stratum corneum to soften and increase co-efficient of friction. Another factor is that mask and goggles used are produced in standard size and do not fit all HCWs with different facial size and shapes [10,12,16,31]. Moreover, they have not been designed for long term use [33,35].…”

“…Although its has been stated in DRPIs International Consensus Document (2020) [9] that placement of prophylactic dressings under stiff devices will decrease the risk of DRPIs [9]. It was demonstrated that if these prophylactic dressings are placed under devices after being cut to shape, they reduce skin deformations formed by the contact between the skin and the device [31]. In the laboratory study of Peko Cohen et al (2019) [29], they examined by using finite element method the effect of the prophylactic dressings cuts under the non-invasive ventilation mask against compressive and frictional forces.…”

Does Wearing a Face Mask During the COVID-19 Pandemic Increase the Incidence of Dermatological Conditions in Health Care Workers? Narrative Literature Review

“…Conflicting evidence was reported on whether hydrocolloid dressings impacted the seal of facial masks [ 6 , 16 , 19 ].…”

Comparing the quantitative fit-testing results of half-mask respirators with various skin barriers in a crossover study design: a pilot study

“…However, their study was limited to three participants and lacked statistical analysis on the quantitative results. Of note, similar studies in the literature used non-validated tests or unrelated outcomes to assess masks’ fit factors’, such as oxygen saturation, or focused on solutions to prevent patient, rather than clinician, skin breakdown [ 16 , [21] , [22] , [23] ].…”