A numerical analysis of skin–PPE interaction to prevent facial tissue injury

Abstract

The use of close-fitting PPE is essential to prevent exposure to dispersed airborne matter, including the COVID-19 virus. The current pandemic has increased pressure on healthcare systems around the world, leading to medical professionals using high-grade PPE for prolonged durations, resulting in device-induced skin injuries. This study focuses on computationally improving the interaction between skin and PPE to reduce the likelihood of discomfort and tissue damage. A finite element model is developed to simulate the movement of PPE against the face during day-to-day tasks. Due to limited available data on skin characteristics and how these vary interpersonally between sexes, races and ages, the main objective of this study was to establish the effects and trends that mask modifications have on the resulting subsurface strain energy density distribution in the skin. These modifications include the material, geometric and interfacial properties. Overall, the results show that skin injury can be reduced by using softer mask materials, whilst friction against the skin should be minimised, e.g. through use of micro-textures, humidity control and topical creams. Furthermore, the contact area between the mask and skin should be maximised, whilst the use of soft materials with incompressible behaviour (e.g. many elastomers) should be avoided.

Influencing factors of medical device-related pressure ulcers in medical personnel during the COVID-19 pandemic: A systematic review and meta-analysis

“…The study [ 17 ] showed that the incidence of MDRPU in COVID-19 intensive care was 87.3% (n = 887), and the incidence of MDRPU in COVID-19 clinic was 85.7% (n = 887). The high incidence of MDRPU among medical staff in COVID-19's department may be due to the use of N95 masks, goggles and face screens [ 40 , 41 ]: firstly, the pressure and friction caused by N95 masks, goggles and face screens themselves; Secondly, medical staff should press the metal nose clip on the nose of the mask and use a tightened elastic rope to ensure the sealing of the mask. This kind of material with small contact area and hard texture will increase the pressure on local tissues.Thirdly, medical personnel wear N95 masks, goggles and face screens for a long time to work with high intensity.…”

Evaluation of evidence of prevention and management of facial pressure injuries in medical staff

“…The use of a skin protectant is highly recommended. The following reasons may explain the high incidence of pressure injuries (Chen et al, 2020 ; Jobanputra et al, 2021 ; Smart et al, 2020 ). First, the damage is directly attributed to the pressure and friction caused by PPE.…”

Incidence of facial pressure injuries in health‐care professionals during the COVID‐19 pandemic: A systematic review and meta‐analysis

“…At present, the COVID-19 global pandemic remains active, and PPE is still the most effective measure for preventing the spread of the disease (Mahmood et al, 2020). The higher incidence of pressure injuries among HCPs may be due to the following factors (Alves et al, 2020;Jobanputra et al, 2021;Smart et al, 2020). The first is Studies have shown (Pittman et al, 2015) that the risk of pressure injuries related to PPE is significantly correlated with the time the PPE is used.…”

“…Of concern, that study by Beam et al (2018) showed that only 2% of nurses performed airtightness checks correctly (Beam et al, 2018). HCPs cannot guarantee airtightness, so they choose to compress the metal nose clip on the nose of the mask and use a tightened elastic cord in attempts to make their mask airtight (Jobanputra et al, 2021), which will increase the pressure on local tissues. It can be seen that during a major infectious disease pandemic, the lack of knowledge and anxiety of HCPs can eventually cause facial pressure injuries.…”

“…During the long‐term pandemic of the disease, increasing numbers of HCPs are suffering from facial pressure injuries related to PPE (People's Daily, 2021). Many factors have been involved in the pressure injury caused by PPE, including pressure, friction, sweating, time and the degree of airtightness between the PPE and the skin (Gefen & Ousey, 2020a, 2020b; Jobanputra et al, 2021). When HCPs wear PPE, their faces are pressed at the fixed part for a long time, which leads to repeated friction on their skin.…”