Pressure injuries related to N95 respirator masks among healthcare workers during the COVID-19 pandemic

Abstract

The coronavirus disease 2019 (COVID-19) pandemic outbreak, which started in 2019, has affected millions of patients globally. 1 Singapore is not spared, being one of the first countries to import COVID-19 cases from China. 2 Nosocomial transmission of SARS-CoV-2 had been reported in various cohort studies of healthcare workers (HCWs), highlighting the importance of effective hospital infection control policies to mitigate risk. 3 In the process of protecting oneself from the SARS-CoV-2 infection, many of our HCWs suffered from skin issues ranging from pressure injuries to other skin-related lesions. While most existing literature surrounding pressure injuries is centred around patients, literature on pressure injuries in HCWs from personal protective equipment (PPE), though scarce, is rapidly emerging as the pandemic continues. A study conducted during the 2013 severe acute respiratory syndrome (SARS) outbreak in Singapore reported more than 50% adverse skin reactions resulting from PPE. 4 The aim of our study is to examine the cross-sectional prevalence of pressure-related injuries among HCWs as a result of N95 masks in a tertiary healthcare institution during the COVID-19 pandemic.An online questionnaire was designed to include all HCWs (doctors, nurses, allied health workers and ancillary staff) who were actively involved in patient care since the start of the COVID-19 pandemic in Singapore. Participation in this survey was optional and voluntary (see Supplementary Materials Appendix 1 in the online version of this article). The questionnaire was disseminated via Survey Monkey, an online survey platform (Momentive Inc, San Mateo, US) and was available for a duration of 3 weeks between July and August 2020. At the time of survey, N95 masks used at our institution were the 3M 8210, 3M 1860, 3M 1860S, 3M 8110S and 3M 1870+. The definition of pressure injury was defined using the standard guidelines from the National Pressure Injury Advisory Panel. 4 Relevant data were collected and analysis using SPSS Statistics software version 24 (IBM Corp, Armonk, US). Univariate analysis was done using t-test for normally distributed continuous variables and chi-square test for categorical variables. Spearman's rank-order correlation (ρ) was used for ordinal variables. Multivariate