Health Problems and Skin Damages Caused by Personal Protective Equipment: Experience of Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units
Sinu Jose, Maneesha C Cyriac, Manju Dhandapani
Adverse skin reactions, Coronavirus, COVID-19, Frontline nurses, Health problems, Personal protective equipment, PPE-related dermatitis
Citation Information :
Jose S, Cyriac MC, Dhandapani M. Health Problems and Skin Damages Caused by Personal Protective Equipment: Experience of Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units. Indian J Crit Care Med 2021; 25 (2):134-139.
Background: In the event of coronavirus disease-2019 (COVID-19) spread worldwide, frontline healthcare workers play a key role in the containment of this devastating pandemic, and to prevent the cross-transmission and gain confidence in battle with the pandemic, they are wearing personal protective equipment (PPE). Aim and objective: To explore the adverse health problems and skin reactions caused by the use of PPEs among the frontline nurses in the ICUs of COVID hospital. Materials and methods: A cross-sectional study was conducted using an online-based questionnaire assessing the physical problems, and adverse skin reactions of PPEs were sent among the 150 frontline nurses in ICUs of COVID hospital. The collected data were analyzed using descriptive statistics. Results: We got 137 valid responses from frontline nurses, and the most common adverse health effects expressed by them were headache (73.4%), extreme sweating (59.6%), and difficulty in breathing (36.7%); 91.7% complained about the fogging of the goggle. Majority of frontline nurses expressed nasal bridge scarring (76.64%) and indentation and pain on the back of the ears (66.42%) as the adverse skin reactions after wearing N95 masks. The common skin problems identified due to double gloving of latex gloves were excessive skin soakage with sweat (70.07%) and skin chapping (19%). The protective clothing caused minimal adverse reactions, and excessive sweating (71.53%) was the most reported. Conclusion: The healthcare workers wearing PPE for a prolonged period show significant adverse effects, so appropriate strategies should be taken to prevent the adverse effects by designing effective PPEs and education of preventive measures among healthcare workers.
Verbeek JH, Ijaz S, Mischke C, Ruotsalainen JH, Mäkelä E, Neuvonen K, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev 2016;4:CD011621. DOI: 10.1002/14651858.CD011621.
Jose S, Dhandapani M, Cyriac MC. Burnout and resilience among frontline nurses during COVID-19 pandemic: a cross sectional study in the emergency department of a tertiary care center, North India. Indian J Crit Care Med 2020;24(11):1081–1088. DOI: 10.5005/jp-journals-10071-23667.
Seto WH, Tsang D, Yung RW, Ching TY, Ng TK, Ho M, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet 2003:361(9368);1519–1520. DOI: 10.1016/s0140-6736(03)13168-6.
Teleman MD, Boudville IC, Heng BH, Zhu D, Leo YS. Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore. Epidemiol Infect 2004;132(5): 797–803. DOI: 10.1017/s0950268804002766. PMID: 15473141; PMCID: PMC2870165.
Karia R, Gupta I, Khandait H, Yadav A, Yadav A. COVID-19 and its modes of transmission. SN Compr Clin Med 2020:1–4. DOI: 10.1007/s42399-020-00498-4. Epub ahead of print. PMID: 32904860; PMCID: PMC7461745.
Guo ZD, Wang ZY, Zhang SF, Li X, Li L, Li C, et al. Aerosol and surface distribution of severe acute respiratory syndrome Coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerg Infect Dis 2020;26(7):1583–1591. DOI: 10.3201/eid2607.200885. Epub 2020 Jun 21. PMID: 32275497.
van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020;382(16):1564–1567. DOI: 10.1056/NEJMc2004973. Epub 2020 Mar 17. PMID: 32182409.
Salvagioni DAJ, Melanda FN, Mesas AE, González AD, Gabani FL, Andrade SM. Physical, psychological and occupational consequences of job burnout: a systematic review of prospective studies. PLoS One 2017;12(10):e0185781. DOI: 10.1371/journal.pone.0185781. PMID: 28977041; PMCID: PMC5627926.
Mahak C, Shashi, Yashomati, Hemlata, Manisha N, Sandhya G, et al. Assessment of Utilization of Rehabilitation Services among Stroke Survivors. J Neurosci Rural Pract 2018;9(4):461–467. DOI: 10.4103/jnrp.jnrp_25_18. PMID: 30271034; PMCID: PMC6126306.
Dhandapani M, Kaur S, Das K, Guru RR, Biswal M, Mahajan P, et al. Enhancing the safety of frontline healthcare workers during coronavirus disease: a novel real-time remote audiovisual aided doffing approach. Infect Dis 2020;1–3. Available from https://www.tandfonline.com/doi/full/10.1080/23744235.2020.1836390.
Lockhart SL, Duggan LV, Wax RS, Saad S, Grocott HP. Personal protective equipment (PPE) for both anesthesiologists and other airway managers: principles and practice during the COVID-19 pandemic. Can J Anaesth 2020;67(8):1005–1015. DOI: 10.1007/s12630-020-01673-w. Epub 2020 Apr 23. PMID: 32329014; PMCID: PMC7178924.
Hu K, Fan J, Li X, Gou X, Li X, Zhou X. The adverse skin reactions of health care workers using personal protective equipment for COVID-19. Medicine (Baltimore) 2020;99(24):e20603. DOI: 10.1097/MD.0000000000020603. PMID: 32541493; PMCID: PMC7302613.
Foo CC, Goon AT, Leow YH, Goh CL. Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome—a descriptive study in Singapore. Contact Dermatitis 2006;55(5):291–294. DOI: 10.1111/j.1600-0536.2006.00953.x. PMID: 17026695; PMCID: PMC7162267.
Lim EC, Seet RC, Lee KH, Wilder-Smith EP, Chuah BY, Ong BK. Headaches and the N95 face-mask amongst healthcare providers. Acta Neurol Scand 2006;113(3):199–202. DOI: 10.1111/j.1600-0404.2005.00560.x.
Zhou NY, Yang L, Dong LY, Li Y, An XJ, Yang J, et al. Prevention and treatment of skin damage caused by personal protective equipment: experience of the first-line clinicians treating 2019-nCoV infection. Int J Dermatol Venereol 2020:10.1097/JD9.0000000000000085. DOI: 10.1097/JD9.0000000000000085. PMCID: PMC7147274.
Tang MB, Leow YH, Ng V, Koh D, Goh CL. Latex sensitisation in healthcare workers in Singapore. Ann Acad Med Singap 2005;34(5): 376–382. PMID: 16021228
Dhandapani M, Gupta S, Mohanty M, Gupta SK, Dhandapani S. Trends in cognitive dysfunction following surgery for intracranial tumors. Surg Neurol Int 2016;7(Suppl 7):S190–S195. DOI: 10.4103/2152-7806.179229. PMID: 27114854; PMCID: PMC4825349.
Dhandapani M, Dhandapani S, Agarwal M, Mahapatra AK. Pain perception following different neurosurgical procedures: a quantitative prospective study. Contemp Nurse 2016;52(4):477–485. DOI: 10.1080/10376178.2016.1222240.
Sahoo SK, Dhandapani S, Singh A, Gendle C, Karthigeyan M, Salunke P, et al. COVID-19: changing patterns among neurosurgical patients from North India, efficacy of repeat testing and inpatient prevalence. Neurosurg Focus 2020;49(6):E7. DOI: 10.3171/2020.9.FOCUS20705.
Cook TM. Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic – a narrative review. Anaesthesia 2020;75(7):920–927. DOI: 10.1111/anae.15071. Epub 2020 Apr 28. PMID: 32246849.
Ong JJ, Bharatendu C, Goh Y, Tang JZ, Sooi KW, Tan YL, et al. Headaches associated with personal protective equipment—a cross-sectional study among frontline healthcare workers during COVID-19. Headache 2020;60(5):864–877. DOI: 10.1111/head.13811.
Bishopp A, Oakes A, Antoine-Pitterson P, Chakraborty B, Comer D, Mukherjee R. The preventative effect of hydrocolloid dressings on nasal bridge pressure ulceration in acute non-invasive ventilation. Ulster Med J 2019;88(1):17–20
Desai SR, Kovarik C, Brod B, James W, Fitzgerald ME, Preston A, et al. COVID-19 and personal protective equipment: treatment and prevention of skin conditions related to the occupational use of personal protective equipment. J Am Acad Dermatol 2020;83(2):675–677. DOI: 10.1016/j.jaad.2020.05.032. Epub 2020 May 15. PMID: 32416206; PMCID: PMC7228687.
Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, et al. Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: a large-scale cross-sectional study. EClinicalMedicine 2020;24:100424. DOI: 10.1016/j.eclinm.2020.100424. PMID: 32766539; PMCID: PMC7320259.
Dhandapani M, Dhandapani S. Challenges posed by COVID-19 and neurosurgical nursing strategies in developing countries. Surg Neurol Int 2020;11(441):1.
Dubaniewicz MT, Rottach DR, Yorio PL. Quality Assurance Sampling Plans in US Stockpiles for Personal Protective Equipment: A Computer Simulation to Examine Degradation Rates. Health Secur 2019;17(4):324-333. DOI: 10.1089/hs.2019.0042. PMID: 31433277; PMCID: PMC6823634.