Study Shows PPE Use In The COVID-19 Fight Is Causing Serious Skin Injuries

04 May, 2020 F.J. Thomas


Sarasota, FL ( – Front line healthcare workers are said to be paying yet another price in the fight against COVID-19. An article published in Advances in Wound Care, a peer-reviewed journal from publishers Mary Ann Liebert, Inc  is coauthored by Chinese researchers Qixia Jiang, Nanjing University School of Medicine (Nanjing, China) along with several other Chinese clinicians. The article details their findings of an online survey on the side effects of PPE use among front line healthcare workers.

The survey was available for two weeks in February of this year via the WeChat social platform. A total of 4,306 participants from 161 hospitals in 28 provinces responded. Males made up 12 percent of the respondents, and females made up 88 percent. Nurses comprised the majority of the group at 88.3 percent, while doctors made up 11.7 percent. The average age was 32, while 67.4 were below the age of 35, and 32.6 percent were aged 35 or older.

PPE was classified into two categories:

  1. Grade 2 was used for those with moderate risk exposure and included masks with goggles or protective face masks, and protective gowns.
  2. Grade 3 was used for workers with high risk exposure and included N95/KN95 respirators with goggles or protective face masks, protective gowns, latex gloves and shoes.

Injuries were also classified into three different categories that were defined by 2019 International Guide for Prevention and Treatment of Pressure Ulcer/Injury, and CMS; Device-related pressure injury (DRPI); Moisture-associated skin damage (MASD), and Skin tears (ST).

The average daily wear time of the PPE used was 7.7 hours, with 14.3 percent wearing PPE for less than 4 or more hours, and 85.7 percent for more than 4 hours. Over a third of those surveyed indicated they experienced heavy sweating while wearing the PPE.

Overall, 1,844 or 42.8 percent of the participants had 4,735 skin injuries. This averaged out to 2.6 skin injuries per person. A total of 27.4 percent of participants had two or more types of injuries, while 76.8 percent indicated that they had injuries on multiple body parts.

DRPI injuries accounted for 30 percent of the total injuries; MASD injuries accounted for 10.8 percent, and ST injuries totaled 2 percent. A total of 78.8 percent of respondents indicated that they had coexisting DRPI and MASD injuries, 13.2 percent stated they had coexisting DRPI, MASD and ST injuries. Only 7 percent reported having DRPI and ST, and 1 percent reported having a MASD and ST injury.

Of the DRPI injuries reported, 81 percent presented with stage 1 injuries where the skin is not broken but the redness does not fade for 30 minutes after the pressure is removed. The average healing time of these injuries is 3 days, and according to the 2019 guideline, patients are at risk for more severe pressure injuries.

Stage 2 injuries accounted for 18.3 percent of the DRPI injuries reported. Stage 2 is when there is partial thickness skin loss with exposed dermis and patients actually have a sore. The average healing time can be 3 days to two weeks. A total of 8 individuals reported deep tissue injury.

More males than females reported injuries, and more doctors than nurses had a higher injury rate as well. Injuries in males totaled 59.7 percent while females with injuries totaled 40.5 percent. The injury rate in doctors totaled 51.9 percent while nurse injuries totaled 41.6 percent.

The level of PPE and wearing time also seemed to be a factor as well. Grade 2 wearers totaled 21 percent of the injuries while Grade 3 accounted for 88.5 percent of the injuries. Wearing PPE for more than 4 hours resulted in 47.3 percent of the injuries, while wearing PPE for less than 4 hours accounted for 18.7 percent of injuries.

There were differences in injury rates as well when those surveyed were grouped by age. Respondents over the age of 35 accounted for 46.3 percent of the injuries while those under the age of 35 totaled 41.2 percent.

Additionally, it seems that patient care and settings could factor in to the skin injuries seen in staff. For instance, DRPI injury rates were higher when a patient was on a respirator in comparison to other treatment methods.   MASD injuries were lower when patients were treated in ICU than when the patients were being treated for chronic wounds.

The full article is available until the end of May on the Mary Ann Liebert, Inc website.

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    About The Author

    • F.J. Thomas

      F.J. Thomas has worked in healthcare business for more than fifteen years in Tennessee. Her experience as a contract appeals analyst has given her an intimate grasp of the inner workings of both the provider and insurance world. Knowing first hand that the industry is constantly changing, she strives to find resources and information you can use.

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