Let’s face it; it doesn’t take a rocket scientist to reach the general conclusion that, yes, this year has been a difficult one. Especially for those on the front lines, the health workers who continue to work for our safety.
That said, it is our duty to look out for those who look out for us. With the impact of the COVID-19 virus reaching the global scale it has, not only must we continue to let science lead the way in how we respond, but we must also monitor the responsive measures we have taken. It’s imperative that we observe how those necessary protective measures affect those who rely on them most to keep them safe.
One emerging topic that requires our attention as industry professionals refers to dermatological issues resulting from prolonged personal protective equipment use. This also includes pressure injuries from PPE.
Our health workers are required to use face masks and face shields for extended periods in this new climate of healthcare, and will continue to for the sake of their personal health and the health of their families. So let’s take a closer look at what preventative steps can be taken to minimize the sorts of “adverse skin events” (already prevalent among health workers) which have seen an increase since the outbreak of the COVID-19 virus due to prolonged PPE use.
Reduce localized pressure and friction in favor of more uniform pressure distribution.
According to Dr. InYoung Kim (MD, PhD) of Practice Update, “for contact or irritant dermatitis due to masks” use of alcohol-free barrier film wipes or thin foam dressings behind the ears, along with “wearing N95 mask straps on the crown of the head to minimize contact with ears” is a good start.
Contact dermatitis increases with frequency of movement, repeated rubbing and the like, so the better we secure these masks on the head while limiting the contact with the ears the more we reduce the risk of our healthcare workers experiencing these adverse skin events.
Consider the use of hydrogel, hydrocolloid, and foam dressings for the benefits they provide.
Also straight from Kim’s key take-home messages in the Journal of the American Academy of Dermatology, “to prevent and treat pressure-related facial skin injury, a thin hydrocolloid or foam dressing can be worn under surgical masks and an alcohol-free barrier wipe can be applied to areas of direct contact prior to wearing N95 masks.”
This is to prevent contact dermatitis after prolonged PPE use on the areas that are most susceptible on the face, those which experience the most
pressure from the equipment and has the potential to cause the sort of “pressure erythema on the nose and zygomatic regions; eczematous lesions in a more severe case.” You can see these here, taken from an article out of the PMC US National Library of Medicine National Institutes of Health.
Use of hydrogel dressings, hydrocolloid dressings, and foam dressings are commonly used in clinical practice to prevent stress injuries.
Follow a step-by-step approach to mitigate the risk of these skin-related conditions.
Of all the information we scoured to prepare this article for your use, there were many in-depth and step-by-step guideline graphics like the one shown here from Medline Industries on Skin Health. They offer various skin protectants, barriers, and moisturizers that you can apply to all the mentioned areas which call for the most attention. The most important part, however, is that some method or procedure be followed to protect the user from pressure related injuries resulting from PPE use.
Assess the damage caused by PPE and take corrective measures that suit the damage’s profile.
In the cases where skin-adverse events are not able to be prevented, they can still be assessed for severity and accounted for in a manner that best serves the individual without need for treatment.
For example, in another article published by PMC, “For small sterile blisters, the epidermis is kept intact, and the blister fluid will be absorbed without intervention. For blisters with a large area or high tension, a sterile syringe is used to suction out the fluid from the bottom of the blister, topical antibiotic ointment is applied, and epidermal loss should be avoided. If there is erosion and exudation, the wound is washed with physiological saline after disinfection. Antibiotic ointment is required for infection prevention.”
This shows how severity dictates the level of treatment. Additionally, choosing a dressing to accompany the level of severity is something to consider here.
In cases that exhibit a high-level of exudate, an alginate or foam dressing with high levels of absorption can best suit the need. In cases where a medium amount of exudate is found, a hydrocolloid dressing may be more suitable. Finally, in the case of dry wounds or those wounds with a lesser amount of exudate found, hydrogel would be the best dressing for the job.
Take into account preexisting conditions and how this might be affected by prolonged use of PPE.
Both allergic and infectious skin conditions will play a role in how prolonged PPE use will affect your skin.
For example, the second article cited from the PMC US National Library of Medicine states “The appearance of eczema is often related to the impaired permeability of PPE or skin barrier damage caused by excessive washing.” It points to moisturization as being a critical step here in the restoration of the skin barrier.
In situations like these there are various ointments and creams which can be utilized to mitigate the effects caused by PPE in accordance with this skin condition.
We hope this article answered some of the questions you might have had surrounding skin conditions emergent in health workers in the field using PPE most frequently. We want to thank those brave workers as they continue to fight for our health, and let it be known we are here to help and support you as you arm your workers with what they need to stay safe during these tumultuous times.
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