Skin adverse events related to personal protective equipment: a systematic review and meta‐analysis

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global pandemic that has spread all over the word. To avoid the virus transmission, healthcare workers (HCWs) must wear adequate personal protective equipment (PPE). PPE is associated with several side events, including skin reactions. The objective of this study is to summarize the prevalence, type and risk factors for cutaneous adverse events related to PPE and prevention measures to avoid them. A systematic review and metanalysis was conducted using Medline, Scopus and Embase databases from conception to 21 st January 2021. All types of epidemiological studies regarding skin adverse events related to PPE were included. The literature search identified 1,007 references, 35 of them met the eligible criteria and were included for analysis, representing 31,453 participants. The media of skin side events related to PPE was 75.13%. The rate of cutaneous adverse events related to mask was 57.71% and those associated with gloves and hand hygiene products was 49.16%.Most common skin adverse events were contact dermatitis, acne and itching. The most damaged anatomical regions were the nasal bridge, the cheeks and the hands. The duration of PPE wearing was the most common risk factor. Frequent hand washing, gloves and masks were the agents most frequently related to skin reactions. N95 respirators were the most harmful mask type for the skin.Hydrocolloid use prevented from developing skin adverse events related to masks. In conclusion, the rate of cutaneous adverse events related to PPE use is high. A longer duration of PPE wearing was the most common risk factor. Using hydrocolloid could prevent from skin injuries related to mask use.

Physiotherapy management for COVID-19 in the acute hospital setting and beyond: an update to clinical practice recommendations

“…Masks that offer airborne protection increase the risk of these conditions occurring over the nasal bridge and cheeks, and the duration that PPE is worn appears to be the most common risk factor. 103 , 104 Hydrocolloid dressings can be used to prevent the development of adverse skin reactions related to masks. 103 , 104 …”

“… 103 , 104 Hydrocolloid dressings can be used to prevent the development of adverse skin reactions related to masks. 103 , 104 …”

Skin-related problems associated with the use of personal protective equipment among health care workers during the COVID-19 pandemic: A online survey study

“…Therefore, the use of PPE is the focus of employee safety for HCWs, which are at the frontline during the pandemic. However, another aspect brought out by the use of PPE during the COVID-19 pandemic is the skin-related injuries and dermatological problems caused by the use of one or more PPE during long and uninterrupted working hours [ [8] , [9] , [10] ]. The necessity of using PPE to ensure infection control in this process has shown that this non-medical equipment that comes into contact with skin and tissues can also cause skin injuries and should be considered within the scope of medical device-related pressure injuries [ [11] , [12] , [13] ].…”

“…Pressure, friction and shear forces that PPEs cause at the contact points on the skin are the main factors in the etiology of skin damage associated with the use of PPE [ 9 ]. It is also known that sweating and moisture, which happen due to stress and discomfort caused by long hours of work with PPE that is used to prevent transmission by contact, droplets, and respiration, leading to skin softening by reducing tissue tolerance and providing the ground for skin injury [ 8 , 9 , 14 , 15 ]. Moreover, the fact that HCWs with different face sizes and shapes have to use the equipment, especially masks and safety glasses, that are manufactured in standard sizes, for a long time also leads to these injuries [ 12 , 16 ].…”

Knowledge & Usage of Personal Protective Equipment for Prevention of Infection Among Frontline Health Care Workers During Covid – 19 Pandemic

“…Nasal bridge, hands, cheeks, periocular, and perioral regions were the most frequently involved areas. 24 A study conducted in Hubei, China documented a high prevalence (97%) of skin manifestations including dryness, redness, erythema and itching in front line health care workers using PPE during the pandemic. Most common area affected was nasal bridge.…”