Prolonged PPE usage can cause skin injuries, warns study

The study, to be published in the journal Advances in Wound Care, looked at 4,308 health care respondents from across 28 provinces in China and found that 42.8% had some form of skin injury related to PPE.

Prolonged personal protective equipment (PPE) use can lead to serious skin injuries, a study covering 161 hospitals treating Covid-19 patients in China has found, and said that preventive measures be institutionalised for doctors and nurses at the forefront of the battle against the contagion.

The most common forms were device-related pressure injuries, moisture-associated skin damage, and skin tears, and they were sometimes found at multiple parts of the same health care worker’s body.(Vipin Kumar/HT file photo. Representative image)

The study, to be published in the journal Advances in Wound Care, looked at 4,308 health care respondents from across 28 provinces in China and found that 42.8% had some form of skin injury related to PPE.

The most common forms were device-related pressure injuries, moisture-associated skin damage, and skin tears, and they were sometimes found at multiple parts of the same health care worker’s body.

The PPE was worn on average daily for 7.7 hours and roughly a third of respondents reported heavy sweating while wearing them.

Two kinds of PPE were considered: Grade 2, comprising surgical masks with goggles or protective face masks and protective gowns used for moderate risk of exposure to the virus; and Grade 3, N-95 respirators with goggles or protective face masks, protective gowns, latex gloves, and shoes used by staff with a high risk of exposure to the virus, often in intensive care units or isolation wards.

Men formed 12% of the respondents while women 88%. Almost 12% of the respondents (11.7%) were doctors and 88.3% were nurses.

The study found that the prevalence of skin injuries was higher in men than women, in doctors than in nurses, in ones wearing Grade 3 PPE than in ones wearing Grade 2 PPE and those wearing the equipment for more than four hours daily than in ones who used it for less than four hours. The researchers also found that older people and those who sweated heavily suffered more injuries.

In many cases, the kind of injuries on doctors and nurses were more severe than those in patients they were treating. The susceptible parts of skin injuries in medical staff were on the nose bridge, cheeks, ears, and forehead, the study found.

“These significant findings are consistent with independent observations in Europe and United States, and call for systematic studies addressing skin injury and repair in Covid-19 patients as well as in their health care providers,” said Chandan K Sen, a professor at Indiana University.

The researchers offered several reasons for the injuries. The first, while staff using PPE should be replaced every four hours, because of the pandemic, many worked for 8-12 hours continuously.

“Of their long hours wearing PPE, the N-95 respirators or surgical masks and goggles would compress nose-bridge and cheeks, a mask strap would compress the ears, and face shield and surgical cap would compress the forehead, which might be the main cause of skin injuries on multiple parts of the head and face,” the study said.

Moreover, the researchers said sweating caused redness, pain, itching, or prickling, which might be the main cause of skin damage. “Soaked skin combined with pressure increased friction coefficient between the PPE and skin, and when masks and goggles were removed quickly, skin tear was ready to happen,” the study added.

In India, where many doctors and nurses are working round the clock, health care staff faces similar problems, said experts. “Because of the pandemic and long duty hours of doctors and nurses, many complained of excessive sweating and restricted movement with PPE. Duty hours should not be more than six hours,” said Girish Tyagi, member, the Delhi Medical Council