Management of skin damage of health workers’ face: the role of plastic surgery in the time of Pandemic (original) (raw)
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Journal of Tissue Viability, 2021
The present study was carried out as a comparative observational study in order to determine the effect of prophylactic dressing on the prevention of skin injuries due to the use of personal protective equipment (PPE) in health care workers (HCWs) working with COVID-19 patients. In addition, the effect of nasal strip on the prevention of discomfort in breathing with mask was also investigated. Materials and methods: The present study was carried out with 48 HCWs (Control Group-CG, n = 20; Experimental Group 1-EG1, n = 20; Experimental Group 2-EG2, n = 8) who use PPE on the face region and work with COVID-19 patients. Data was collected with Data Collection Form developed by researchers. In participants in CG, normal procedures of the institution in using PPE were followed. In EG1, prophylactic dressing was used on risky areas on the face. In EG2, nasal strip sticky on one side was used in addition to prophylactic dressing. The evaluation of the facial skin was made once a day by a researcher with expertise in wound management. Results: Groups were similar in terms of demographic characteristics of participants. Overall rate of skin injuries associated with PPE use was 47.9%. Skin injuries developed in all participants in CG (n = 20), and in two and one participants in EG1 and EG2 respectively, with significant difference between groups. The most common skin injuries were Stage 1 pressure injury (29.2%), blanchable erythema of intact skin (27.1%) and itching (18.8%). No participant in EG2 reported discomfort in breathing (n = 8). Significant difference was found between groups in favor of EG2 in terms of experiencing discomfort in breathing (p < 0.001). Conclusions: In the present study, it was established that using prophylactic dressing under PPE prevents skin injuries on the facial skin and using nasal strip prevents discomfort in breathing with mask. In view of these results, it was recommended that prophylactic dressing should be used under PPE.
Revista Latino-americana De Enfermagem, 2022
Skin injuries due to Personal Protective Equipment and preventive measures in the COVID-19 context: an integrative review* Highlights: (1) The main PPE items responsible for the occurrence of skin injuries are masks. (2) Acne and stage 1 and 2 pressure ulcers are the main types of skin injury. (3) The main skin injury prevention measures involve routine care measures. (4) Health professionals usually do not adopt preventive measures when using PPE. Objective: to identify the diverse scientific evidence on the types of skin lesions caused due to the use of Personal Protective Equipment in health professionals during the COVID-19 pandemic and to verify the recommended prevention measures. Method: this is an integrative review carried out in the MEDLINE, CINAHL, LILACS, SCOPUS, Science Direct, Web of Science and SciELO databases. The search was conducted in a paired manner, constituting a sample of 17 studies categorized according to the types of skin lesions and preventive measures. Results: the main types of skin lesions related to mask use were stage 1 pressure ulcers, acne and cutaneous depression. Regarding the use of glasses and face shields, the most frequent were stage 1 and 2 pressure ulcers. Xerosis and irritant contact dermatitis occurred due to using gloves and protective clothing, respectively. The main preventive measures recommended were using hydrocolloid or foam dressing in the pressure regions, moisturizers and emollients. Conclusion: a considerable number of skin lesions associated with using the equipment were noticed, and the data obtained can guide the professionals in identifying risks and promoting preventive measures to avoid their occurrence.
The study aimed to determine skin related issues in health care workers as a result of applying personal protective equipment (PPE) in Pakistan. Quantitative descriptive cross-sectional study was conducted to determine skin related issues in Karachi-Pakistan from May to October 2021. A sample size of 52 health workers was selected through the purposive sampling technique. Validity and reliability of the questionnaire were established. All ethical issues were strictly adhered to. The study revealed that majority of the participants were within the age group 26-35 years, majority were nurses, majority did not apply any type of skin care related products or material, majority were comfortable with the use of PPE, and majority of those who applied PPE had broken skin. In conclusion, the study yielded that the trend of adverse events was also related to the number of consecutive days of PPE use and the type and model of PPE. Comment Considering the rate at which the COVID-19 infection spread across the globe with its morbidity effects, frontline health
Journal of the Dow University of Health Sciences
Objective: To investigate the adverse events on skin with continuous practice of personal protective equipment (PPE) in COVID-19 management among healthcare workers. (HCWs) Methods: This cross-sectional multicenter study was conducted at hospitals operating in Karachi, Pakistan from November 2020 to January 2021. The target population was HCWs including doctors, paramedical staff, postgraduate, and undergraduate students involved in the care of patients during COVID-19; and continuously wearing , such as masks, gloves, and protective level 3 barrier protection personal protective equipment (L3PPE) clothing. Adverse effect was defined as presence of new onset obvious skin damages with continuous PPE used during used COVID-19 management. Results: Of 383 HCWs, adverse effect was observed in 168 (43.9%) HCWs. The most common adverse effects because of facial mask were indentation and ear pin 200 (52.2%), by gloves was dry skin 186 (48.8%), by gown was wheals 19 (7.0%), and by goggles was pressure injury 40 (43.0%). A significantly higher association of adverse effect of using L3PPE was found with age >27 years (p-value <0.031), eczema and asthma as preexisting diseases (p-value <0.001), ≤10 times daily standard hand hygiene procedure (p-value 0.002), >6 hours of PPE worn per day (p-value <0.001), N-95 mask use (p-value 0.029), both OPD and isolation ward work setting (p-value <0.001), and systematic features like, headache (p-value 0.019), sneezing (p-value <0.001), feeling of intense heat (p-value <0.001), claustrophobia (p-value <0.001), and facial suffusion (p-value <0.001). Conclusion: A higher number of HCWs reported adverse effects of L3PPE continuously usage during COVID-19 management.
Journal of the American Academy of Dermatology, 2020
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. both, we ruled out herpes simplex virus and varicella zoster virus clinically and by performing polymerase chain reaction. Most patients who presented with an erythematous rash had mild itch. There was no correlation between the presence of rash and fever. Involved sites were primarily the trunk and upper limbs, but the head and face were largely spared. In this group, younger patients seem to display more intense and disseminated cutaneous manifestations, including darker red, larger wheal-like and purpuric lesions. All exanthems were short-lived and resolved spontaneously without specific dermatologic treatment after mean of 3 days (range, 2-5 days). The dermatologic manifestations could not be correlated to COVID-19 severity. Diffuse petechiae, gravity-dependent, and multiple, generalized palpable purpura, and acroischemia (primarily finger/toe cyanosis, but neither skin bulla nor dry gangrene) were seen in more severe cases. These manifestations were associated with clotting disorders, reflected in increased prothrombin time and fibrinogen and D-dimer levels, which are seen in intensive care patients. 3-5 In conclusion, some patients with COVID-19 present with inflammatory cutaneous findings: 7.8% in our cohort of hospitalized adults. These skin findings are generally mild and self-limiting and do not correlate with overall prognosis. They generally resolve promptly without specific therapy.
Facial skin injuries caused by individual protectors in the combat to covid-19
RGO - Revista Gaúcha de Odontologia
The single-stranded ribonucleic acid coronavirus is the seventh known member of the Coronaviridae family to infect humans. The droplets and aerosols that are suspended in the air with the virus can be transmitted by contact with the oral, nasal and eye mucosa, which can cause severe acute respiratory syndrome. Due to the outbreak of the new coronavirus disease, the constant use of personal protective equipment by health professionals has become necessary, as the virus has a rapid and widespread spread. But, unexpectedly, the coronavirus outbreak brought another concern, the emergence of facial injuries due to the continuous and inappropriate use of these individual protectors, harming the health of these professionals. An alternative to alleviate and prevent such injuries would be the use of prophylactic creams and dressings in places where there is pressure caused by these equipment, as well as relieving the loads generated by them, at intervals that do not exceed 4 hours. Therefor...
International Journal of Research in Dermatology, 2021
Background: The use of personal protective equipment (PPE) around the world in view of COVID-19 pandemic has led to high incidence of occupational dermatoses amongst healthcare workers (HCWs). Amongst all staff members visiting dermatology services, irritant dermatitis (body, hand) and acne form eruption remained the most common concerns. Apart from improving staff morale and quality of life, prevention and management of these conditions will also minimize the risk of breaching stringent PPE protocol. Preventive strategies including frequent breaks from PPE and less than 6 hours of continuous PPE usage can make the working environment more conducive for HCWs.Methods: A quantitative descriptive research-based study is utilized, in which participants who fulfilled the required criteria were selected and were asked to fill the questionnaire. Results were analysed.Results: Redness and itching are the commonest complaints encountered followed by skin rash and acne. Facial occupational de...
Bali Dermatology and Venereology Journal
Since declared as a global pandemic by World Health Organizations on 11th March 2020, per early July 2020, COVID-19 total confirmed cases count had surpassed 11 million cases. COVID-19 poses a new challenge to healthcare workers with a new standard of care and managing COVID-19 patients. Healthcare workers must adhere to stricter hand hygiene, and the new Personal Protective Equipment (PPE) protocol brings forth new problems for healthcare workers. Skin problems have become the most common and preventable adverse effects of the daily and prolonged use of PPE. This could inadvertently cause protocol breaches, such as mask touching, scratching, or off-protocol PPE adjustment. Damage in the skin could also cause discomfort, and skin exposure may serve as a new port of entry for a secondary infection. In this study, we review various studies regarding the adverse effects, prevention, and therapy of the skin problems related to COVID-19 PPE use.
World journal of surgery and surgical research, 2020
Chronic wounds are an important burden for all the healthcare systems in the world. Their management requires constant follow up by specialized personnel and daily care by patients themselves. The spread of COVID-19 pandemic and the need for social distancing and limited hospital access caused significant limitation of patients' access to treatment, affecting in particular chronic wounds patients. In fact, due to the advanced age and the associated comorbidities, they are patients at higher risk of infection and lethality from COVID-19. In addition, an increase of Pressure Ulcers (PU) was observed worldwide, due to the dramatic number of patients immobilized in Intensive Care Unit (ICU), with systemic viral infection. Furthermore, prone position pressure
WCET Journal, 2020
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.