The Prevalence, Characteristics, and Prevention Status of Skin Injury Caused by Personal Protective Equipment Among Medical Staff in Fighting COVID-19: A Multicenter, Cross-Sectional Study

Abstract

Objective: To investigate the prevalence, characteristics, and preventive status of skin injuries caused by personal protective equipment (PPE) in medical staff. Approach: A cross-sectional survey was conducted online for understanding skin injuries among medical staff fighting COVID-19 in February 8-22, 2020. Participants voluntarily answered and submitted the questionnaire with cell phone. The questionnaire items included demographic data, grade of PPE and daily wearing time, skin injury types, anatomical sites, and preventive measures. Univariable analyses and logistic regression analyses were used to explore the risk factors associated with skin injuries. Results: A total of 4,308 respondents were collected from 161 hospitals and 4,306 respondents were valid. The overall prevalence of skin injuries was 42.8% (95% confidence interval [CI] 41.30-44.30) with three types of devicerelated pressure injuries, moist-associated skin damage, and skin tear. Co-skin injuries and multiple location injuries were 27.4% and 76.8%, respectively. The logistic regression analysis indicated that sweating (95% CI for odds ratio [OR] 87.52-163.11), daily wearing time (95% CI for OR 1.61-3.21), male (95% CI for OR 1.11-2.13), and grade 3 PPE (95% CI for OR 1.08-2.01) were associated with skin injuries. Only 17.7% of respondents took prevention and 45.0% of skin injuries were treated. Innovation: This is the first cross-sectional survey to understand skin injuries in medical staff caused by PPE, which is expected to be a benchmark. Conclusion: The skin injuries among medical staff are serious, with insufficient prevention and treatment. A comprehensive program should be taken in the future.

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

“…Researchers found a statistically significant difference in the number of injuries sustained if HCPs exceeded this time frame in PPE. 22 Skin protection under masks is therefore a necessity because shift lengths can be unpredictable based on PPE supplies 23 but also because facial injuries have been noted in shorter shift periods 22 and within 2 hours in this study.…”

“…A different cross-sectional study 22 (N = 4,306) from China on facial injuries sustained by HCPs when using PPE also identified this 4-hour cut-off time. Researchers found a statistically significant difference in the number of injuries sustained if HCPs exceeded this time frame in PPE.…”

“…It is of vital importance that hours of PPE wear (regardless of facial protection applied) be documented 3 to prevent prolonged exposure, excessive moisture build-up, and skin breakdown. Based on the experience of aggressive frontline COVID-19 care in Wuhan, 7,22 it is recommended that each 8-hour shift be divided between two teams where one team does the work requiring N95 mask wear (in the dirty/infected area) while the rest works in the clean area. After 4 hours inside without eating, drinking, or a bathroom break in full PPE, the two teams switch.…”

Personal protective equipment use in laparoscopy during COVID-19

“…[ 1 ] There are studies which showed the prevalence of skin injuries due to heavy sweating and long period of wearing Grade 3 PPE during work. [ 2 ]…”

Skin changes attributed to protective measures againstCOVID‐19: A compilation

“…Prevalence of injuries was higher in males, doctors (as compared to nurses), ones wearing grade 3 PPE, those with daily wearing time >4 hours, those over 35 years old, and the ones with heavy sweating. 4 In another report, prevalence of skin damage was 97.0%, nasal bridge being the most commonly affected site (83.1%). 5 The skin changes associated with protective measures can be seen in four scenarios:…”