Adverse Skin Reactions to Personal Protective Equipment Among Health-Care Workers During COVID-19 Pandemic: A Multicenter Cross-sectional Study in Indonesia

Abstract

Objective: Health-care workers (HCWs) in Indonesia have been participating in the war against the coronavirus disease-2019 since March 2020. Ever since HCWs were exposed to the regular use of personal protective equipment (PPE) with varying levels and maintain hand hygiene more as recommended by the World Health Organization. Adverse skin reactions to PPE in Indonesia has yet to be acknowledged. This study aimed to study the prevalence and characteristics-, possible risk factors-, and suggest possible solutions towards adverse skin reactions to PPE among HCWs in a multi-center setting of Indonesia. Methods: A cross-sectional survey was conducted online among HCWs in the Siloam Hospitals Group of Banten province. HCWs of Banten Province were surveyed from June 1 to August 31, 2020. The data was obtained using avalidated online survey questionnaire including (1) demographic characteristics; (2) occupational-related characteristics; (3) adverse skin reactions. Results: A response rate of 40.2% was obtained and 200 valid respondents were yielded. The mean age of respondents was (26.94 ± 7.23) years old. Adverse skin reactions (66.5%) were reported primarily in female (73.7%) working as doctors (82.7%) of a non-referral center for coronavirus disease-2019 (60.2%) wearing level 2 and 3 PPE (43.6% and 37.6%, respectively). The cheeks and chin was the most common site involved (69.9%) with dryness/tightness (63.9%) and acne (77.4%) as the highest symptoms and signs reported. Sex, age group classification, level of PPE worn, hand hygiene frequency, and duration of PPE worn daily were factors considerably associated with adverse skin reactions to PPE (P < 0.05). Conclusions: Adverse skin reactions to PPE are common among HCWs in Indonesia. Comprehensive strengthening of the skin condition and awareness on adverse skin reactions should be advocated.

The Association of the Prolonged Use of Personal Protective Equipment and Face Mask During COVID-19 Pandemic With Various Dermatologic Disease Manifestations: A Systematic Review

“…Of the initial 70 articles, only 10 met the full inclusion criteria [12][13][14][15][16][17][18][19][20][21] (Table 1). The ten included studies varied slightly in their study designs; for example, seven of them were cross-sectional studies [12,13,15,[18][19][20][21], one was a prospective study [14], and one was quantitative descriptive [17]. Only one study did not specify the used study design [16].…”

“…Concerning study locations, two were performed in the United Kingdom [12,14]; three studies in China [16][17][18]; and single studies from India [13], Thailand [15], Brazil [19], Iraq [20], and Indonesia [21]. There were three studies that did not specify the PPE investigated and used by the participants [12,19,20].…”

“…Another study investigating the impact of wearing level-2 and level-3 PPE reported a prevalence of skin reactions of 66.5%, of which 73.7% were females, 82.7% were doctors, and 43.6% of them had only worn level-2 PPE. The prolonged wearing of PPE for >seven hours, gender, age, the frequency of hand hygiene, and the level of PPE worn were associated with the adverse skin reactions among HCWs [ 21 ].…”

“…Also, wearing the surgical mask was a risk factor for developing adverse skin reactions compared to wearing a cloth mask [ 15 ]. Though level III PPE was associated with discomfort [ 16 ] and skin injuries [ 18 ], a study reported that level two PPE resulted in a higher frequency of skin reactions (43.6%) compared to level III PPE (37.6%) [ 21 ]. The type of skin reaction and complication was affected by the type of protective measures used; wearing N95 masks was associated with nasal bridge scarring and facial itching, whereas latex gloves resulted in dry skin, itching, and rashes, and wearing protective clothing resulted in dry skin and itching [ 17 ].…”

Double Face Mask Use for COVID-19 Infection Prevention and Control Among Medical Students at Makerere University: A Cross-Section Survey

“…Although there is some published evidence that increased tightness which might be a result of double masking may be a predisposing factor for adverse skin reactions, in the current study, this was of very low impact in our study. 26 In fact, most participants in our study aimed at improving the tightness of masks to achieve maximal protection.…”