Personal protective equipment used by COVID-19 medical staff may cause serious skin injuries: Study

More than 40 per cent of medical staff treating COVID-19-infected patients may experience serious skin injury related to the use of personal protective equipment such as masks, goggles, face shields, and protective gowns, according to a study.

According to the scientists, including those from Medical School of Nanjing University in China, the skin injuries put staff at increased risk of infection, with insufficient prevention and treatment measures in place.

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The study, published in the journal Advances in Wound Care, noted three main types of personal protective equipment (PPR)-related skin injuries -- device-related pressure injuries, moist associated skin damage, and skin tear.

It said there are several factors which increased the risk for skin injury such as heavy sweating, greater daily wearing time, and using grade 3 versus grade 2 PPE.

Men were also more prone to skin injury than women, the scientists noted in the study.

The researchers also found differences in the types of injuries sustained by different body parts due to the protective equipments.

"Susceptible parts of skin injuries in medical staff were on nose bridge, cheeks, ears, and forehead," they said.

In patients, device related pressure injuries were mainly located on ears and feet, and moisture-associated skin damage occurred on skin fold, and peri-wounds, the study noted.

Citing reasons for these injuries, the scientists said long hours of wearing PPE, the N95 respirators or surgical masks, and goggles compress the nose bridge and cheeks of doctors and healthcare workers.

They said the mask strap may also compress the ears, and the face shield and surgical cap tend to compress the forehead, leading to skin injuries on multiple parts of head and face.

According to the researchers, male workers tended to be at more risk than the female staff likely due to more sweating observed in men, and poor attention to daily skin care given by Chinese men compared to women.

Only 45 per cent of the respondents, according to the study, adopted hydro-colloid dressing, oil or cream to treat their injuries, indicating that prevention and treatment was insufficient.

The scientists believe that medical staff and managers ignored skin protection at early stage.

They said staff in front line may be receiving no training on how to prevent and treat skin injuries.

Some workers may be worried about using dressings to protect their nose bridge and cheeks, thinking that doing so may make the mask and goggles to not close enough and possibly increase infection risk, the scientists suspected.

They suggested that managers pay attention to skin protection and seek rational allocation of medical resources.

Citing a limitation of the study, the researchers said it was difficult to observe the adverse outcome of skin injuries among medical staff and impossible to compare the results of prevention and treatment measures.

They added that further studies on this can help overcome this limitation.

"These significant findings are consistent with independent observations in Europe and the US, 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 from the Indiana University School of Medicine in the US.