Best-practices for preventing skin injury beneath personal protective equipment during the COVID-19 pandemic: A position paper from the National Pressure Injury Advisory Panel.
Journal
Journal of clinical nursing
ISSN: 1365-2702
Titre abrégé: J Clin Nurs
Pays: England
ID NLM: 9207302
Informations de publication
Date de publication:
Feb 2023
Feb 2023
Historique:
revised:
11
11
2020
received:
30
06
2020
accepted:
07
01
2021
pubmed:
4
2
2021
medline:
17
1
2023
entrez:
3
2
2021
Statut:
ppublish
Résumé
COVID-19 has infected millions of patients and impacted healthcare workers worldwide. Personal Protective Equipment (PPE) is a key component of protecting frontline clinicians against infection. The benefits of PPE far outweigh the risks, nonetheless, many clinicians are exhibiting skin injury caused by PPE worn incorrectly. These skin injuries, ranging from lesions to open wounds are concerning because they increase the susceptibility of viral infection and transmission to other individuals. Early into the COVID-19 pandemic (April 2020), the U. S. National Pressure Injury Advisory Panel (NPIAP) developed a series of position statements to improve wear-ability of PPE and protect healthcare professionals and their patients as safe from harm as possible under the circumstances. The NPIAP positions, which were formed by conducting a systematic review of what was known at the time, include: (a) Prepare skin before and after wearing PPE with skin sealants, barrier creams and moisturisers; (b) Frequent PPE offloading to relieve pressure and shear applied to skin; (c) treat visible skin injuries immediately caused by PPE to minimise future infection; (d) non-porous dressings may provide additional skin protection, but lack evidence; (e) health systems should take care to educate clinicians about placement and personal hygiene related to handling PPE. Throughout all of these practices, handwashing remains a top priority to handle PPE. These NPIAP positions provided early guidance to reduce the risk of skin injury caused by PPE based on available research regarding PPE injuries, a cautious application of evidence-based recommendations on prevention of device-related pressure injuries in patients and the expert opinion of the NPIAP Board of Directors. Clinicians who adhere to these recommendations reduce the prospects of skin damage and long-term effects (e.g. scarring). These simple steps to minimise the risk of skin injury and reduce the risk of coronavirus infection from PPE can help.
Identifiants
pubmed: 33534939
doi: 10.1111/jocn.15682
pmc: PMC8013459
doi:
Types de publication
Systematic Review
Journal Article
Langues
eng
Pagination
625-632Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR001854
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR001854
Pays : United States
Informations de copyright
© 2021 John Wiley & Sons Ltd.
Références
Beiu, C., Mihai, M., Popa, L., Cima, L., & Popescu, M. N. (2020). Frequent hand washing for COVID-19 prevention can cause hand dermatitis: management tips. Journal of Cureus, 12(4), e7506.
Bischoff, W. E., Turner, J., Russell, G., Blevins, M., Missaiel, E., & Stehle, J. (2018). How well do N95 respirators protect healthcare providers against aerosolized influenza virus? Infection Control and Hospital Epidemiology, 40(2), 232-234. https://doi.org/10.1017/ice.2018.326
Bothra, A., Das, S., Singh, M., Pawar, M., & Maheswari, A. (2020). Retroauricular dermatitis with vehement use of ear loop face masks during COVID-19 pandemic. Journal of the European Academy of Dermatology and Venereology, 34(10), e549-e552. https://doi.org/10.1111/jdv.16692
Cai, J. Y., Zha, M. L., & Chen, H. L. (2019). Use of a hydrocolloid dressing in the prevention of device-related pressure ulcers during noninvasive ventilation: A meta-analysis of randomized controlled trials. Wound Management & Prevention, 65(2), 30-38.
Dai, T., Zaman, M. H., Padula, W. V., & Davidson, P. M. (2021). Supply chain failures amid Covid-19 signal a new pillar for global health preparedness. Journal of Clinical Nursing, 30(1-2), e1-e3. https://doi.org/10.1111/jocn.15400
Darlenski, R., & Tsankov, N. (2020). COVID-19 pandemic and the skin: what should dermatologists know? Clinics in Dermatology, 38(6), 785-787.
Desai, S. R., Kovarik, C., Brod, B., James, W., Fitzgerald, M. E., Preston, A., & Hruza, G. J. (2020). COVID-19 and personal protective equipment: Treatment and prevention of skin conditions related to the occupational use of personal protective equipment. Journal of the American Academy of Dermatology, 83(2), 675-677.
Donovan, J., Kudla, I., Holness, L. D., Skotnicki-Grant, S., & Nethercott, J. R. (2007). Skin reactions following use of N95 facial masks. Journal of Dermatitis, 18(2), 104.
Eaglstein, W. H., & Sullivan, T. (2005). Cyanoacrylates for skin closure. Dermatologic Clinics, 23(2), 193-198. https://doi.org/10.1016/j.det.2004.09.003
Edsberg, L. E., Black, J. M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016). Revised national pressure ulcer advisory panel pressure injury staging system: revised pressure injury staging system. Journal of Wound, Ostomy and Continence Nursing, 43(6), 585-597. https://doi.org/10.1097/won.0000000000000281
European Pressure Ulcer Advisory Panel, National Pressure Ulcer Advisory Panel, & Pan-Pacific Pressure Injury Alliance (2019). Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. In E. Haesler (Ed.), EPUAP/NPIAP/PPPIA.
Gefen, A. (2020). Skin tears, medical face masks, and coronavirus. Wound Management & Prevention, 66(4), 6.
Gefen, A., Cohen, L., Amrani, G., Hoffer, O., & Ovadia-Blechman, Z. (2019). The roles of infrared thermography in pressure ulcer research with focus on skin microclimate induced by medical devices and prophylactic dressings. Wounds International, 10(1), 8-15.
Gefen, A., & Ousey, K. (2020a). COVID-19: pressure ulcers, pain and the cytokine storm. Journal of Wound Care, 29(10), 540-542. https://doi.org/10.12968/jowc.2020.29.10.540
Gefen, A., & Ousey, K. (2020b). Prevention of skin damage caused by the protective equipment used to mitigate COVID-19. Journal of Wound Care, 29(6), 311. https://doi.org/10.12968/jowc.2020.29.6.311
Gefen, A., & Ousey, K. (2020c). Update to device-related pressure ulcers: SECURE prevention. COVID-19, face masks and skin damage. Journal of Wound Care, 29(5), 245-259. https://doi.org/10.12968/jowc.2020.29.5.245
Gurses, A. P., Dietz, A. S., Nowakowski, E., Andonian, J., Schiffhauer, M., Billman, C., Abashian, A. M., Trexler, P., Osei, P., Benishek, L. E., Xie, A., Pronovost, P., Rosen, M. A., & Maragakis, L. L. (2019). Human factors-based risk analysis to improve the safety of doffing enhanced personal protective equipment. Infection Control and Hospital Epidemiology, 40(2), 178-186. https://doi.org/10.1017/ice.2018.292
Hu, K., Fan, J., Li, X., Gou, X., Li, X., & Zhou, X. (2020). The adverse skin reactions of health care workers using personal protective equipment for COVID-19. Medicine (Baltimore), 99(24), e20603. https://doi.org/10.1097/md.0000000000020603
Ippolito, M., Vitale, F., Accurso, G., Iozzo, P., Gregoretti, C., Giarratano, A., & Cortegiani, A. (2020). Medical masks and Respirators for the Protection of Healthcare Workers from SARS-CoV-2 and other viruses. Pulmonology, 26(4), 204-212. https://doi.org/10.1016/j.pulmoe.2020.04.009
Jiang, Q., Song, S., Zhou, J., Liu, Y., Chen, A., Bai, Y., Wang, J., Jiang, Z., Zhang, Y., Liu, H., Hua, J., Guo, J., Han, Q., Tang, Y., & Xue, J. (2020). 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. Advances in Wound Care (New Rochelle), 9(7), 357-364 https://doi.org/10.1089/wound.2020.1212
Jinadatha, C., Simmons, S., Dale, C., Ganachari-Mallappa, N., Villamaria, F. C., Goulding, N., Tanner, B., Stachowiak, J., & Stibich, M. (2015). Disinfecting personal protective equipment with pulsed xenon ultraviolet as a risk mitigation strategy for health care workers. American Journal of Infection Control, 43(4), 412-414. https://doi.org/10.1016/j.ajic.2015.01.013
Jones, D., Stoler, G., & Suyama, J. (2013). Effectiveness of three just-in-time training modalities for N-95 mask fit testing. American Journal of Disaster Medicine, 8(4), 283-286. https://doi.org/10.5055/ajdm.2013.0135
Kottner, J., Cuddigan, J., Carville, K., Balzer, K., Berlowitz, D., Law, S., Litchford, M., Mitchell, P., Moore, Z., Pittman, J., Sigaudo-Roussel, D., Yee, C. Y., & Haesler, E. (2019). Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019. Journal of Tissue Viability, 28(2), 51-58. https://doi.org/10.1016/j.jtv.2019.01.001
Lenski, M., & Scherer, M. A. (2016). Contamination of workwear in medical doctors and nursing stuff. Orthopade, 45(3), 249-252, 254-245. https://doi.org/10.1007/s00132-016-3226-0
Li, J. O., Lam, D. S. C., Chen, Y., & Ting, D. S. W. (2020). Novel Coronavirus disease 2019 (COVID-19): The importance of recognising possible early ocular manifestation and using protective eyewear. British Journal of Ophthalmology, 104(3), 297-298. https://doi.org/10.1136/bjophthalmol-2020-315994
Lyder, C. H., Yu, C., Stevenson, D., Mangat, R., Empleo-Frazier, O., Emerling, J., & McKay, J. (1998). Mar). Braden Scale for the prediction of pressure ulcer risk in blacks and Latino/Hispanic elders: a pilot study. Ostomy Wound Manage, 44(3A Suppl), 42S-49S. discussion 50S.
Manero, A., Smith, P., Koontz, A., Dombrowski, M., Sparkman, J., Courbin, D., & Chi, A. (2020). Leveraging 3D printing capacity in times of crisis: recommendations for COVID-19 distributed manufacturing for medical equipment rapid response. International Journal of Environmental Research and Public Health, 17(13), 4634. https://doi.org/10.3390/ijerph17134634
Padula, W. V., Mishra, M. K., Makic, M. B., & Sullivan, P. W. (2011). Improving the Quality of Pressure Ulcer Care with Prevention: a cost-effectiveness analysis. Medical Care, 49(4), 385-392.
Padula, W. V., Pronovost, P. J., Makic, M. B. F., Wald, H. L., Moran, D., Mishra, M. K., & Meltzer, D. O. (2019). Value of hospital resources for effective pressure injury prevention: a cost-effectiveness analysis. BMJ Quality & Safety, 28(2), 132-141. https://doi.org/10.1136/bmjqs-2017-007505
Parnham, A., Copson, D., & Loban, T. (2020). Moisture-associated skin damage: causes and an overview of assessment, classification and management. British Journal of Nursing, 29(12), S30-s37. https://doi.org/10.12968/bjon.2020.29.12.S30
Parush, A., Wacht, O., Gomes, R., & Frenkel, A. (2020). Human factor considerations in using personal protective equipment in the COVID-19 pandemic context: binational survey study. Journal of Medical Internet Research, 22(6), e19947. https://doi.org/10.2196/19947
Patel, A., D'Alessandro, M. M., Ireland, K. J., Burel, W. G., Wencil, E. B., & Rasmussen, S. A. (2017). Personal protective equipment supply chain: lessons learned from recent public health emergency responses. Health Security, 15(3), 244-252. https://doi.org/10.1089/hs.2016.0129
Reddy, M., Gill, S. S., & Rochon, P. A. (2006). Preventing Pressure Ulcers: a systematic review. JAMA, 296(8), 974-984.
Roberts, V. (2014). To PAPR or not to PAPR? Canadian Journal of Respiratory Therapy, 50(3), 87.
Rowan, N. J., & Laffey, J. G. (2020). Challenges and solutions for addressing critical shortage of supply chain for personal and protective equipment (PPE) arising from Coronavirus disease (COVID19) pandemic - Case study from the Republic of Ireland. Science of the Total Environment, 725, 138532. https://doi.org/10.1016/j.scitotenv.2020.138532
Rundle, C. W., Presley, C. L., Militello, M., Barber, C., Powell, D. L., Jacob, S. E., Atwater, A. R., Watsky, K. L., Yu, J., & Dunnick, C. A. (2020). Hand hygiene during COVID-19: Recommendations from the American Contact Dermatitis Society. Journal of the American Academy of Dermatology, 83(6), 1730-1737. https://doi.org/10.1016/j.jaad.2020.07.057
The National Pressure Injury Advisory Panel (NPIAP) (2020). COVID-19 Resources. Retrieved from https://npiap.com/page/COVID-19Resources
Tomas, M. E., Kundrapu, S., Thota, P., Sunkesula, V. C., Cadnum, J. L., Mana, T. S., Jencson, A., O’Donnell, M., Zabarsky, T. F., Hecker, M. T., Ray, A. J., Wilson, B. M., & Donskey, C. J. (2015). Contamination of health care personnel during removal of personal protective equipment. JAMA Internal Medicine, 175(12), 1904-1910. https://doi.org/10.1001/jamainternmed.2015.4535
Towfigh, S., Cheadle, W. G., Lowry, S. F., Malangoni, M. A., & Wilson, S. E. (2008). Significant reduction in incidence of wound contamination by skin flora through use of microbial sealant. Archives of Surgery, 143(9), 885-891. https://doi.org/10.1001/archsurg.143.9.885
U.S. Centers for Disease Control and Prevention. (2020). Healthcare Workers: Facemasks. Coronavirus Disease 2019 (COVID-19). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
Vincent, A. G., Kadakia, S., Barker, J., Mourad, M., Saman, M., & Ducic, Y. (2019). Management of facial scars. Facial Plastic Surgery, 35(6), 666-671. https://doi.org/10.1055/s-0039-3401642
Visscher, M. O., White, C. C., Jones, J. M., Cahill, T., Jones, D. C., & Pan, B. S. (2015). Face masks for noninvasive ventilation: fit, excess skin hydration, and pressure ulcers. Journal of Respiratory Care, 60(11), 1536-1547. https://doi.org/10.4187/respcare.04036
Yin, J., Singh, R. B., Al Karmi, R., Yung, A., Yu, M., & Dana, R. (2019). Outcomes of cyanoacrylate tissue adhesive application in corneal thinning and perforation. Cornea, 38(6), 668-673. https://doi.org/10.1097/ico.0000000000001919