Personal protective equipment (PPE) may protect healthcare workers from COVID-19, but 42.8% of those treating patients infected with the virus experienced serious skin injury, according to researchers at the Nanjing University School of Medicine. Also, these injuries increased the risk of infection with insufficient prevention and treatment measures in place.
The three main types of PPE-related skin injuries included device-related pressure injuries (DRPI), moist associated skin damage (MASD), and skin tear (ST). Factors increasing the risk for skin injury include heavy sweating, greater daily wearing time, being male, and the use of grade 3 PPE instead of grade 2.
“These significant findings are consistent with independent observations in Europe and the United States and call for systematic studies addressing skin injury and repair in COVID-19+ patients as well as in their healthcare providers,” said Chandan K. Sen, PhD, editor in chief of Advances in Wound Care, which published the study.
The study comprised 2,732 respondents who were among the first healthcare workers fighting the virus in Wuhan emergency departments, screening clinics, infectious departments, intensive care units, and isolation wards as well as voluntary participants who all wore PPE such as surgical masks, goggles, face masks, protective gowns, respirators, gloves, and shoes.
According to the study, 1,844 respondents had 4,735 skin injuries, or 2.6 skin injuries each. Also, 78.8% had coexistence of DRPI and MASD, 13.2% had DRPI, MASD, and ST, 7.0% had DRPI and ST, and 1.0% had MASD and ST. Stage 1 injuries were reported by 81.1% of respondents, 18.3% suffered from stage 2, and 0.6% had deep tissue injury.
These injuries were more prevalent in:
- Males than females (59.7% versus 40.5%)
- Doctors than in nurses (51.9% versus 41.6%)
- Those wearing grade 3 PPE than in those wearing grade 2 (88.5% versus 21.0%)
- Those wearing PPE longer than four hours than in those with daily wearing time equal to or less than four hours (47.3% versus 18.7%)
- Those older than 35 than those younger than 35 (46.3% versus 41.2%)
- Those with heavy sweating than those without heavy sweating (91.3% versus 17.8%)
Only 17.7% of respondents used prophylactic dressings and lotions to protect their skin. Also, only 40% of those with sweating and who wore grade 3 PPE took preventive measures. Plus, only 45.0% of respondents with injuries adopted hydrocolloid dressing, oil, or cream to treat these injuries.
Prevention and treatment of these skin injuries were insufficient, the researchers said, because medical staff and managers ignored skin protection during the early stages of the pandemic. Also, medical staff received no training in prevention, and little was known about how to use dressings. Relevant preventive resources were inadequate as well.
The researchers believe that there should be adequate preparation for skin injuries during public health emergencies in addition to rational allocation of medical resources. Also, they said, medical staff should be trained in skin protection, and protective products should be chosen according to guidelines. Products should be improved for the future as well.
The study, “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,” was published by Advances in Wound Care.
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