PPE-related skin injuries emerge during COVID-19

June 16, 2020

Eczema from PPE

COVID-19 has caused an increase in the use of PPE (personal protective equipment); an emerging issue of PPE-related skin issues has also increased.  The Nurses Specialized in Wound, Ostomy, and Continence Care (NSWOCC) recently published a report on Prevention and Management of Skin Damage Related to Personal Protective Equipment. 

Skin injuries related to PPE  

Observations of PPE-related skin injuries include: 

  • pressure injuries 

  • contact dermatitis  

  • hives 

  • itching 

  • moisture-associated skin damage.  

Prolonged use of PPE leads to skin irritation and skin destruction.  

Areas of Exposure for PPE-related skin injuries 

Areas of exposure and injury include the nasal bridge, forehead, cheeks, and hands. Long term glove use leads to moisture imbalance combined with excessive hand washing can lead to irritation and dermatitis. Applying hand cream between handwashing and PPE application is important to prevent skin injury.  

Mild skin irritation due to PPE is often minimized and overlooked. However, minor skin irritation often leads to an increased risk of workers touching their face inadvertently when not wearing PPE.  

Risks of PPE-related skin conditions 

Skin failure due to PPE provides another route for infectious agents to penetrate the body.  

PPE-related skin conditions like dermatitis and eczema and infections increase the risk of itching the skin and prematurely removing PPE. It also leads to a decrease in productivity and absence from work.  

Key recommendations to avoid PPE-Related Skin Injuries:  

1. Continue regular hygiene care before and after PPE use.  

Introduce a barrier or regular moisturizing cream to areas of greater contact with PPE. Consider using an acrylate polymer and/or dimethicone-based cream that last longer.  

2. Moisturize hands regularly.  

Ensure hands are completely clean and dry prior to donning gloves. Allow time for moisturizer to penetrate skin before donning gloves.  Hand cream should contain a minimum of 70% fat. 

3. Dressing material  

Apply dressing material as an interface between PPE and the skin in areas of adhesion, pressure or friction. This needs to be done under occupational health guidance to ensure the dressing does not interfere with fit and seal of a mask.   

4. Relieve Pressure  

Pressure relief for skin contact areas is recommended by removing PPE every 4 hours. Remove PPE immediately if it becomes wet or soiled. 

5. Proper Skin Cleansing and Hydration 

Skin Cleansing and Hydration after PPE removal, the skin should be inspected and thoroughly cleansed with soap and water. Do not rub the skin area under pressure to avoid further damage. Dry the skin and apply a moisturizer. If there is skin damage, a dressing may be required.  

Daily skincare with hydration and protection will aid in maintaining skin integrity and wound prevention. Maintaining optimum nutrition and body hydration are other important factors for skin health.  

The full report with detailed recommendations on dressings can be found online www.nswoc.ca/ppe