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Çakar V, Karadağ A, Bugan B, Kılıç H, Demir AS. Personal Protective Equipment-Related Problems Experienced by Healthcare Workers, Solutions, and Recommendations: A Qualitative Study. Adv Skin Wound Care 2023; 36:1-9. [PMID: 37861670 DOI: 10.1097/asw.0000000000000059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To understand the problems experienced by healthcare workers (HCWs) who used personal protective equipment (PPE) on their face during the COVID-19 pandemic, their interventions to prevent these problems, and their recommendations for improving the quality of PPE. METHODS This descriptive and qualitative study included HCWs (N = 29) from health institutions at different levels in Turkey. Researchers collected data using a semistructured data collection form (13 items) and in-depth individual interviews. Data were analyzed with descriptive statistics and qualitative inductive content analysis. RESULTS Of the 29 participants, 15 (51.7%) were women, and 18 (62.1%) were nurses. Participants' answers regarding problems related to PPE use were grouped into four main categories, answers regarding the prevention of these problems were grouped into three main categories, and answers regarding improving the quality of PPE were grouped into three main categories. Skin concerns were the most commonly reported problems related to PPE, and interventions to prevent these problems primarily related to skin protection and care. Recommendations to improve the quality of PPE focused on using materials for masks and face shields that reduce pressure and friction; participants also suggested that face shields be produced in sterile and disposable packages. CONCLUSIONS This research indicates that HCWs need support and they are able to create individual solutions for the problems with PPE that they experience. Skin-friendly PPE that ensures the safety and comfort of HCWs should be produced, and hospitals should develop policies for institutional use to prevent PPE injury.
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Affiliation(s)
- Vildan Çakar
- Vildan Çakar, PhD, is Assistant Professor, Department of Nursing, School of Health Sciences, Istanbul Medipol University, Istanbul, Turkey. Ayişe Karadağ, PhD, ET/WOCN, is Professor, School of Nursing, Koç University, Istanbul, Turkey. Berna Bugan, BSN, is Staff Nurse, Koç University Hospital. Havanur Kılıç, BSN, and Ayşe Sılanur Demir, BSN, are Research Assistants and PhD Students, Graduate School of Health Sciences, Koç University. Acknowledgment : The authors thank the voluntary participants of the study. The authors have disclosed no financial relationships related to this article. Submitted March 23, 2022; accepted in revised form August 18, 2022
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Lu J, Jiang G. Guarding skin under PPE: Mechanistic insights and technological innovations. Skin Res Technol 2023; 29:e13520. [PMID: 38009022 PMCID: PMC10626285 DOI: 10.1111/srt.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/28/2023]
Abstract
In the presence of diseases transmitted through respiratory droplets and direct contact, healthcare workers (HCWs) necessitate the use of personal protective equipment (PPE). For optimal safety, PPE should securely conform to the skin during extended wear. However, conventional PPE often lacks adequate air permeability and hygroscopicity, trapping heat and moisture emitted by the body within the enclosure. Such a hot and humid internal environment can induce skin damage, such as erythema, rash, pruritus, and itching among others, leading to microbial growth on the skin surface, the production of inflammatory mediators at the wound site and an increased risk of infection. This review strives to comprehensively elucidate the fundamental mechanisms triggering adverse skin reactions and their resultant manifestations. Furthermore, we explore recent advancements aimed at inhibiting these mechanisms to effectively mitigate the occurrence of skin lesions.
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Affiliation(s)
- Junru Lu
- Department of DermatologyAffiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
- Xuzhou Medical UniversityXuzhouJiangsuChina
| | - Guan Jiang
- Department of DermatologyAffiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
- Xuzhou Medical UniversityXuzhouJiangsuChina
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Fallahi F, Rafiei H, Rashvand F, Aali E. ChitoHeal gel use on the nasal site for prevention of N95 masks caused pressure injuries: A randomised clinical trial. Int Wound J 2023; 20:3157-3163. [PMID: 37057654 PMCID: PMC10502251 DOI: 10.1111/iwj.14193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
Prolonged use of personal protective equipment can cause pressure injuries on the skin. The current study was conducted with the aim of investigating the effect of ChitoHeal gel on the nasal site on the prevention of N 95 masks that caused pressure injuries in nurses working in intensive care units. This is a randomised controlled clinical trial that was conducted in 2022. The study sample consisted of 92 nurses working in the intensive care units. A randomised block method was used to allocate the nurses to two equal groups of intervention and control. However, in the intervention group, ChitoHeal gel was applied on nurses' nose bridge. To perform this, the researcher referred to the department during the morning and evening shifts and applied the gel on nurses' nose bridge at the beginning of each shift. Then, the N95 mask was installed on the face by the nurse. Before and at the end of each work shift, the skin in both groups was assessed for any signs of pressure injuries. No significant differences were observed between the two intervention and control groups in terms of demographic variables. The frequency distribution of mask-caused pressure injuries on nurses' nose bridge in the two groups was analysed using the Chi-square test (Fisher's exact test). The results showed that after the intervention, it was 0 in the intervention group. However, 4 nurses (8.6%) in the control group developed pressure injuries, and this difference between the two groups was statistically significant (P > .05). The result of the current study showed that the use of ChitoHeal gel is effective in preventing N95 mask-related pressure injuries. Considering the cheapness and rational global availability of this gel, it seems that its use is an effective strategy in order to prevent N95 mask-related pressure injuries. Given the lack of studies in this regard, similar studies are strongly recommended to be conducted.
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Affiliation(s)
- Fariba Fallahi
- Student Research CommitteeQazvin University of Medical SciencesQazvinIran
| | - Hossein Rafiei
- Social Determinants of Health Research Center, Research Institute for prevention of Non‐Communicable DiseasesQazvin University of Medical SciencesQazvinIran
- Department of Nursing, Qazvin School of Nursing and MidwiferyQazvin University of Medical ScienceQazvinIran
| | - Farnoosh Rashvand
- Social Determinants of Health Research Center, Research Institute for prevention of Non‐Communicable DiseasesQazvin University of Medical SciencesQazvinIran
- Department of Nursing, Qazvin School of Nursing and MidwiferyQazvin University of Medical ScienceQazvinIran
| | - Ehsan Aali
- Department of Pharmacology, School of MedicineQazvin University of Medical SciencesQazvinIran
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Sonenblum SE, Patel R, Phrasavath S, Xu S, Bates-Jensen BM. Using Technology to Detect Erythema Across Skin Tones. Adv Skin Wound Care 2023; 36:524-533. [PMID: 37729162 PMCID: PMC10545068 DOI: 10.1097/asw.0000000000000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/17/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To examine the effectiveness of the ColorMeter DSM III (ColorMeter; Cortex Technology) at grouping individuals by skin tone and measuring erythema/skin discoloration after erythema induction across skin tones. METHODS This pre/post experimental study induced erythema on a convenience sample of 61 healthy adults. Skin tone at baseline was measured using the ColorMeter, Munsell Soil Color Chart 5YR (Munsell), and Pantone SkinTone Guide (Pantone) and compared with the Eumelanin Human Skin Colour Scale (Eumelanin Scale) groupings. Erythema and melanin values on the arm immediately and after recovery time were compared with baseline values. Melanin was measured at five body regions on the face and arm. RESULTS Participants were predominantly women (64% [n = 39] women, 36% [n = 22] men) and young (mean, 28.8 ± 14.3 years); 5% (n = 3) were Hispanic, 26% (n = 16) Asian, 29% (n = 18) Black, 38% (n = 23) White, and 7% (n = 4) identified with more than one race. ColorMeter lightness (L*) and melanin measures were strongly correlated with both Munsell and Pantone values. Munsell skin tone groups were not aligned with Eumelanin Scale groupings. Most participants were in the Eumelanin intermediate-low group, and this changed depending on which body location melanin value was used. The change in erythema from baseline did not differ significantly across skin tone groups at the ulnar head, but on the forearm at the delayed time point, significant differences existed between light and both medium and dark skin tone groups (P = .001; 95% CI, 0.04-0.37). CONCLUSIONS The ColorMeter provides an effective objective measure of skin tone and erythema/discoloration across various skin tones and may improve on current standards for detection. The proposed Eumelanin Scale-Modified provides additional sensitivity for persons with medium skin tones.
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Affiliation(s)
- Sharon Eve Sonenblum
- Sharon Eve Sonenblum, PhD, is Principal Research Scientist, George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA. Rahee Patel, DPT, Sarah Phrasavath, DPT, and Sharon Xu, DPT, are Student Researchers, Emory University, Atlanta. Barbara M. Bates-Jensen, PhD, RN, FAAN, is Professor of Nursing and Medicine, University of California, Los Angeles
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Zhu F, Su H, Kong Y, Xu B, Lv Q, Lin J, Yi L, Xie J. Evaluation of dressings preventing facial medical device-related pressure injury in medical staff during the COVID-19 pandemic: A systematic review and network meta-analysis. J Clin Nurs 2023; 32:5988-5999. [PMID: 37082837 DOI: 10.1111/jocn.16721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/06/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
AIM This study systematically compared the efficacy of various dressings that may prevent facial medical device-related pressure injury (MRDPI) in medical staff during the COVID-19 pandemic. BACKGROUND During the COVID-19 pandemic, medical staff who are required to wear masks, goggles and other personal protective equipment (PPE) are susceptible to facial MRDPI, which exacerbates working conditions. Dressings can effectively prevent or alleviate MRDPI, but it is unclear which dressings are most effective. DESIGN A systematic review and network meta-analysis, in accordance with PRISMA. METHODS A comprehensive literature search was conducted in four English and four Chinese databases to identify relevant studies published up to 8 September 2022. The selected studies were randomised controlled trials, with populations comprising medical staff who wore PPE during the COVID-19 pandemic and included an observation and control group. RESULTS The network meta-analysis of the 12 selected articles showed that foam dressing, hydrocolloid dressing and petrolatum gauze were better than conventional protection for preventing MRDPI. The surface under the cumulative ranking curve indicated that foam dressing was the best preventative. CONCLUSION Foam dressing is more effective than other dressings in preventing facial MRDPI in medical staff. When PPE must be worn for many hours, such as during the COVID-19 pandemic, medical staff can use foam dressings to prevent MRDPI. RELEVANCE TO CLINICAL PRACTICE The results support the use of dressings, especially foam dressings, to prevent MRDPI in healthcare workers. The appropriate dressings are recommended to prevent MRDPI associated with wearing PPE.
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Affiliation(s)
- Fangfang Zhu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Honghong Su
- Nursing College, Fuzhou Institute of Technology, Fuzhou, China
| | - Yue Kong
- Teaching and Research Department, Fuzong Clinical Medical College of Fujian Medical University (The 900th Hospital of Joint Logistic Support Force, PLA), Fuzhou, China
| | - Baoling Xu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Qian Lv
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jiamin Lin
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Luanxing Yi
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jieling Xie
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Ying L, Jiali C, Peifang L, Haiying F, Ning N, Hong C. Prevention of skin damages related to personal protective equipment among healthcare workers: Summary of best-evidence practiced strategies. J Clin Nurs 2023; 32:5596-5606. [PMID: 36871173 DOI: 10.1111/jocn.16647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/10/2023] [Accepted: 01/30/2023] [Indexed: 03/06/2023]
Abstract
AIM To conduct a quality evaluation of the literature for the prevention of skin damage caused by personal protective equipment among healthcare workers and to summarise the best-evidence practice strategies to prevent it. DESIGN Review. METHODS Two researchers retrieved the literature from Web of Science, Public Medicine, etc., from the establishment of the database until 24 June 2022. Appraisal of Guidelines, Research and Evaluation II was used to assess the methodological quality of the guidelines. Expert consensus was assessed by the 2016 version of the Australian Joanna Briggs Institute Evidence-based Health Care Center corresponding evaluation standards. By tracking the original study, the quality of practice recommendations and best-practice evidence information sheets were evaluated by the 2016 version of the Australian Joanna Briggs Institute Evidence-based Health Care Center corresponding evaluation standards. The classification of evidence and recommendation level adopted the 2014 version of the Australian Joanna Briggs Institute evidence pre-grading and recommending level system. RESULTS A total of 5476 studies were retrieved after duplications were eliminated. After the quality evaluation, 10 qualified studies were finally included. All consisted of two guidelines, one best practice information sheet, five practice recommendations, and one expert consensus. The evaluation results of the guidelines were both B-level recommendations. The consistency strength of expert consensus was moderate (Cohen's kappa coefficient = .571). Thirty best-evidence practised strategies were compiled for four elements, including cleaning, moisturising, prophylactic dressings and others. CONCLUSION Our study evaluated the quality of the included studies and summarised the preventive measures of PPE-related skin lesions according to the recommendation level. The main preventive measures were divided into 4 parts and 30 items. However, the associated literature was rare, and the quality was slightly low. More high-quality research is needed to focus on healthcare workers' health and not just skin in the future.
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Affiliation(s)
- Liu Ying
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Jiali
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Li Peifang
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Fu Haiying
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Ning Ning
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Hong
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
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Delmore B, Deppisch M, Cox J, Newton D, Gillespie C, Todd J, Sonenblum SE. Necessary Products for the Prevention and Treatment of Pressure Injuries: Lessons Learned That Translate Beyond the COVID-19 Pandemic. Adv Skin Wound Care 2023; 36:361-369. [PMID: 37338948 DOI: 10.1097/01.asw.0000935996.96447.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To identify the challenges encountered in obtaining the required support surfaces and products to meet pressure injury (PrI) prevention and treatment needs during COVID-19. METHODS The authors used SurveyMonkey to gather data on healthcare perceptions and the challenges experienced regarding specific product categories deemed necessary for PrI prevention and treatment in US acute care settings during the pandemic. They created three anonymous surveys for the target populations of supply chain personnel and healthcare workers. The surveys addressed healthcare workers' perceptions, product requests, and the ability to fulfill product requests and meet facility protocols without substitution in the categories of support surfaces and skin and wound care supplies. RESULTS Respondents answered one of the three surveys for a total sample of 174 respondents. Despite specific instructions, nurses responded to the surveys designed for supply chain personnel. Their responses and comments were interesting and capture their perspectives and insights. Three themes emerged from the responses and general comments: (1) expectations differed between supply chain staff and nurses for what was required for PrI prevention and treatment; (2) inappropriate substitution with or without proper staff education occurred; and (3) preparedness. CONCLUSIONS It is important to identify experiences and challenges in the acquisition and availability of appropriate equipment and products for PrI prevention and treatment. To foster ideal PrI prevention and treatment outcomes, a proactive approach is required to face daily issues or the next crisis.
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Affiliation(s)
- Barbara Delmore
- Barbara Delmore, PhD, RN, CWCN, MAPWCA, IIWCC, FAAN, is Senior Nurse Scientist, Center for Innovations in the Advancement of Care, Department of Nursing, NYU Langone Health, and Clinical Assistant Professor, Hansjörg Wyss, Department of Plastic Surgery, NYU Grossman School of Medicine, New York, New York, USA. Michelle Deppisch, PT, CWS, FACCWS, LLC, is Wound Care Consultant, Hertford, North Carolina. Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, is Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey, and WOC Advanced Practice Nurse, Englewood Health, Englewood, New Jersey. David Newton, MEng, CEng, MIET, MIEEE, is Product Development Manager, Arjo Inc, San Antonio, Texas. Carroll Gillespie, MS, RN, CWOCN, is Clinical Solutions Manager, Wound Care and Bariatrics, Arjo Inc, Addison, Illinois. Jackie Todd, MBA, BSN, RN, CWCN, is Clinical Consultant, Epic Clinical Consulting, Charleston, South Carolina. Sharon Eve Sonenblum, PhD, is Principal Research Scientist, George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia
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Su H, Zhou W, Kong Y, Zhu F, Xu B, Shen X, Zhang W, Zhou Q, Lv Q. Incidence of facial pressure injuries in health-care professionals during the COVID-19 pandemic: A systematic review and meta-analysis. Int J Nurs Pract 2022; 29:e13125. [PMID: 36535903 PMCID: PMC9877937 DOI: 10.1111/ijn.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/14/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the incidence of facial pressure injuries in health-care professionals during the COVID-19 pandemic in a meta-analysis. METHODS Related studies were obtained through electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) Chinese Scientific Journal (VIP) China Biomedical Literature service systems (CBM) and Wanfang Data (from inception to 27 November 2021). The pooled incidence and the 95% confidence interval of facial pressure injuries were calculated with Review Manager v5.4 software. RESULTS Overall, 16 studies with 14 430 health-care professionals were included. Pooled results showed that the pooled incidence of facial pressure injury in health-care professionals was 58.8% (95% CI: 49.0%-68.7%; p < 0.01). The results of the subgroup analysis showed that the incidence of facial pressure injury in these staff was high, and predominantly stage I pressure injury, in the following cases: in health-care professionals who wore personal protective equipment for longer than 4 h, in those without any training experience, and on the nose. CONCLUSION Administrators and researchers should pay attention to preventing facial pressure injury related to the wearing of personal protective equipment (PPE) by ensuring all health-care professionals receive training and by limiting prolonged periods of use.
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Affiliation(s)
- Honghong Su
- Nursing CollegeFujian University of Traditional Chinese MedicineFuzhouChina
| | - Wenguang Zhou
- Department of EquipmentChenggong Hospital of Xiamen University (the 73th Group Military Hospital of the People's Liberation Army)XiamenChina
| | - Yue Kong
- Teaching and Research DepartmentFuzong Clinical Medical College of Fujian Medical University (The 900th Hospital of Joint Logistic Support Force, PLA)FuzhouChina
| | - Fangfang Zhu
- Nursing CollegeFujian University of Traditional Chinese MedicineFuzhouChina
| | - Baoling Xu
- Nursing CollegeFujian University of Traditional Chinese MedicineFuzhouChina
| | - Xianying Shen
- School of NursingFujian Medical UniversityFuzhouChina
| | - Weiqin Zhang
- School of NursingFujian Medical UniversityFuzhouChina
| | - Qijun Zhou
- Medical CollegeQiqihar Medical UniversityQiqiharChina
| | - Qian Lv
- Nursing CollegeFujian University of Traditional Chinese MedicineFuzhouChina
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Su H, Lv Q, Kong Y, Zeng H, Zhou W, Zhu F, Xu B, Zhou Q. Evaluation of evidence of prevention and management of facial pressure injuries in medical staff. Nurs Open 2022; 10:2746-2756. [PMID: 36502522 PMCID: PMC10077380 DOI: 10.1002/nop2.1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/17/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022] Open
Abstract
AIM This systematic review evaluated the quality of evidence for the prevention and management of facial pressure injuries in medical staff. DESIGN This review was presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS We retrieved the relevant studies from 19 databases. Using the literature evaluation standards and evidence grading system of the Australian Joanna Briggs Institute Evidence-Based Health Care Center, we evaluated the quality of the literature encompassing different types of research and assessed their levels of evidence. RESULTS A total of 13 studies were included, including seven expert consensuses, two recommended practices, one clinical decision, one best practice information booklet, one systematic review and one randomized controlled trial. In the end, 31 best evidence were summarized, including skin cleaning and care, PPE placement and movement, reasonable use of dressings, treatment measures and education and training.
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Affiliation(s)
- Honghong Su
- Nursing College Fujian University of Traditional Chinese Medicine Fuzhou China
| | - Qian Lv
- Nursing College Fujian University of Traditional Chinese Medicine Fuzhou China
| | - Yue Kong
- Teaching and Research Department Fuzong Clinical Medical College of Fujian Medical University (The 900th Hospital of Joint Logistic Support Force, PLA) Fuzhou China
| | - Huiling Zeng
- Nursing College Fujian University of Traditional Chinese Medicine Fuzhou China
| | - Wenguang Zhou
- Department of Equipment Chenggong Hospital of Xiamen University (the 73th Group Military Hospital of People's Liberation Army) Xiamen China
| | - Fangfang Zhu
- Nursing College Fujian University of Traditional Chinese Medicine Fuzhou China
| | - Baoling Xu
- Nursing College Fujian University of Traditional Chinese Medicine Fuzhou China
| | - Qijun Zhou
- Medical College Qiqihar Medical University Qiqihar China
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Hamad Vuai SA, Sahini MG, Sule KS, Ripanda AS, Mwanga HM. A Comparative In-vitro Study on Antimicrobial Efficacy of On-Market Alcohol-Based Hand washing Sanitizers towards Combating Microbes and its Application in Combating Covid-19 Global Outbreak. Heliyon 2022; 8:e11689. [PMCID: PMC9670678 DOI: 10.1016/j.heliyon.2022.e11689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/22/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
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Alderden J, Kennerly SM, Cox J, Yap TL. Pressure Injury Risk Assessment and Prevention in Patients With COVID-19 in the Intensive Care Unit. AACN Adv Crit Care 2022; 33:173-185. [PMID: 35657764 DOI: 10.4037/aacnacc2022335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients critically ill with COVID-19 are at risk for hospital-acquired pressure injury, including device-related pressure injury. METHODS Braden Scale predictive validity was compared between patients with and without COVID-19, and a logistic regression model was developed to identify risk factors for device-related pressure injury. RESULTS A total of 1920 patients were included in the study sample, including 407 with COVID-19. Among the latter group, at least 1 hospital-acquired pressure injury developed in each of 120 patients (29%); of those, device-related pressure injury developed in 55 patients (46%). The Braden Scale score area under the receiver operating characteristic curve was 0.72 in patients without COVID-19 and 0.71 in patients with COVID-19, indicating fair to poor discrimination. CONCLUSIONS Fragile skin and prone positioning during mechanical ventilatory support were risk factors for device-related pressure injury. Clinicians may consider incorporating factors not included in the Braden Scale (eg, oxygenation and perfusion) in routine risk assessment and should maintain vigilance in their efforts to protect patients with COVID-19 from device-related pressure injury.
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Affiliation(s)
- Jenny Alderden
- Jenny Alderden is Associate Professor, Boise State University School of Nursing, 1910 University Dr, Boise, ID 83725
| | - Susan M Kennerly
- Susan M. Kennerly is Professor, East Carolina University College of Nursing, Greenville, North Carolina
| | - Jill Cox
- Jill Cox is Clinical Associate Professor, Rutgers University, and Wound, Ostomy, Continence Advanced Practice Nurse, Englewood Health, Newark, New Jersey
| | - Tracey L Yap
- Tracey L. Yap is Associate Professor, Duke University School of Nursing, Durham, North Carolina
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Koti B, Zaveri S, Shah B, Anand S, Tagliaferri AR. Mask-Induced Partial Transection of the External Ear Requiring Complex Surgical Reconstruction. Cureus 2022; 14:e25390. [PMID: 35774717 PMCID: PMC9236676 DOI: 10.7759/cureus.25390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/20/2022] Open
Abstract
During the COVID-19 pandemic, wearing masks to prevent the spread of infection has been imperative. Though many wear N-95 masks with circumferential head straps, the use of surgical ear loop-style masks has increased. Dermatologic complications, such as contact dermatitis, psoriasis, and local irritation, have been described in several reports. One such complication has been pressure injury to the external ear, secondary to friction from the ear loops. While external ear pressure ulcers caused by mask-wearing have already been observed, injuries extensive enough to require surgical reconstruction have yet to be described. Herein, we present a unique case of an elderly male with a severe external ear deformity caused by prolonged, uninterrupted mask-wearing that was treated with a complex ear reconstruction. The pressure caused a full-thickness erosion of the helical and conchal cartilage with partial auricle amputation from constant mask wear. We describe an unusual and interesting problem caused indirectly by the coronavirus pandemic and discuss potential methods to protect oneself against skin injury from mask usage while simultaneously preventing viral transmission.
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Protective equipment-related pressure ulcers in healthcare workers during COVID-19 pandemic: A systematic review. J Tissue Viability 2022; 31:213-220. [PMID: 35210162 PMCID: PMC8856964 DOI: 10.1016/j.jtv.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 01/29/2022] [Accepted: 02/14/2022] [Indexed: 01/17/2023]
Abstract
AIM This systematic review was carried out to examine pressure ulcers in healthcare staff due to the use of protective equipment during COVID-19 pandemic and the precautions taken to prevent these injuries. METHOD Relevant studies were retrospectively searched. Seven English keywords identified from MESH were used while searching. The search was carried out in five international databases by trying various combinations of these words during February 15-25, 2021. This systematic review was updated by rescanning databases on December 20, 2021 and a total of 611 studies were attained. RESULTS 17 studies which met the study inclusion criteria, which were conducted mostly through online survey method in different study designs and which included a total of 24,889 healthcare professionals were examined. The incidence of PPE-related pressure ulcers was found to be between 30% and 92.8%. Grade I pressure ulcers were the most common (44.1%-82%). The incidence of skin problems except PPE-related pressure ulcers such as itching, redness and dry skin was found to be between 42.8-88.1%. Risk factors that frequently played a role in the development of PPE-related pressure ulcers and other skin problems were longer use of PPE and sweating. PPE-related pressure ulcers and other skin problems were more frequent over the nose (nasal bone/nasal bridge), ears, forehead and cheeks. PPE-related itching, redness and dry skin mostly occurred. Several dressing applications were found to be effective in the prevention of PPE-related pressure ulcers and other skin problems that might develop especially on the facial region. CONCLUSION PPE-related pressure ulcers and other skin problems were found to be higher among healthcare professionals. Data regarding the sealing of dressing applications against viral transmission in the prevention of PPE-related pressure ulcers and other skin problems are limited. It is estimated that future studies will be performed to prevent device-related pressure ulcers in healthcare workers. It is suggested that there is a need to conduct studies with larger samples where expert researchers make observations for pressure ulcers in order to determine the prevalence and incidence of PPE-related pressure ulcers.
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Ünver S, Yildirim M, Cansu Yeni̇ğün S. Personal protective equipment related skin changes among nurses working in pandemic intensive care unit: A qualitative study. J Tissue Viability 2022; 31:221-230. [PMID: 35094886 PMCID: PMC8785367 DOI: 10.1016/j.jtv.2022.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/25/2021] [Accepted: 01/20/2022] [Indexed: 01/17/2023]
Abstract
AIM The respiratory tract is the main transmission way of the SARS-CoV-2 virus and nurses who care for COVID-19 patients in intensive care units (ICUs) are required to constantly use personal protective equipment (PPE) during their daily work. This study aimed to examine the PPE-related skin changes experienced by the nurses working in pandemic ICU during the COVID-19 pandemic. METHODS Using a descriptive phenomenological approach, semi-structured interviews were conducted between November 1st and December 25th, 2020, in the pandemic ICU of a training and research hospital in Usak, Turkey. The nurses who worked in the pandemic ICU for at least one week and experienced skin changes due to PPE use were included. Individual interviews were carried out online through video conferencing. Colaizzi's method was used in data analysis by using the ATLAS.ti 8.0. RESULTS The main themes were main causes of PPE-related skin changes, its location along with secondary adverse effects, symptomatology, prevention, and therapeutic interventions used for curing PPE-related skin changes. Nurses mostly reported PPE-related skin changes behind their ears, over their nose, cheeks and jaw due to wearing N95 masks and on the forehead due to wearing face shields. Wearing PPE at least 2 h, the type/quality of PPE, and being dehydrated were identified as the common causes. CONCLUSION This study provides a deeper understanding into the PPE-related skin change experiences of pandemic ICU nurses and the importance of the quality of the PPE used. It is recommended to enable shortened working shifts and ergonomic PPE materials for ICU nurses.
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Affiliation(s)
- Seher Ünver
- Trakya University, Faculty of Health Sciences, Department of Surgical Nursing, Edirne, Turkey,Corresponding author. Trakya University, Balkan Campus, Faculty of Health Sciences, Department of Surgical Nursing, 22020, Edirne, Turkey
| | - Meltem Yildirim
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Seda Cansu Yeni̇ğün
- Akdeniz University, Kumluca Faculty of Health Sciences, Department of Surgical Nursing, Antalya, Turkey
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Yang R, Ke Q, Chan SW, Liu Y, Lin H, Li W, Zhu J. The relationship between frontline nurses’ skin lesions and their anxiety and depression during the COVID‐19 pandemic: exploring the mediating role of fear and resilience. J Nurs Manag 2022; 30:1903-1912. [PMID: 35434883 PMCID: PMC9115287 DOI: 10.1111/jonm.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/25/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
Aim Background Methods Results Conclusion Implications for nursing management
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Affiliation(s)
- Rumei Yang
- School of Nursing, Nanjing Medical University Nanjing city Jiangsu Province P. R. China
| | - Qiaohong Ke
- Department of Gynaecology, Women and Children's Hospital, School of Medicine Xiamen University Xiamen Fujian Province P. R. China
| | | | - Yang Liu
- School of Medicine Xiamen University Xiamen Fujian Province P.R. China
| | - Huicong Lin
- School of Medicine Xiamen University Xiamen Fujian Province P.R. China
| | - Wengang Li
- School of Medicine Xiamen University Xiamen Fujian Province P.R. China
| | - Jiemin Zhu
- School of Medicine Xiamen University Xiamen Fujian Province P.R. China
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Nieto-García L, Carpio-Pérez A, Moreiro-Barroso MT, Ruiz-Antúnez E, Nieto-García A, Alonso-Sardón M. Are there differences between COVID-19 and non-COVID-19 inpatient pressure injuries? Experiences in Internal Medicine Units. PLoS One 2022; 17:e0263900. [PMID: 35176083 PMCID: PMC8853574 DOI: 10.1371/journal.pone.0263900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/29/2022] [Indexed: 12/25/2022] Open
Abstract
Background Pressure Injuries (PIs) are major worldwide public health threats within the different health-care settings. Objective To describe and compare epidemiological and clinical features of PIs in COVID-19 patients and patients admitted for other causes in Internal Medicine Units during the first wave of COVID-19 pandemic. Design A descriptive longitudinal retrospective study. Setting This study was conducted in Internal Medicine Units in Salamanca University Hospital Complex, a tertiary hospital in the Salamanca province, Spain. Participants All inpatients ≥18-year-old admitted from March 1, 2020 to June 1, 2020 for more than 24 hours in the Internal Medicine Units with one or more episodes of PIs. Results A total of 101 inpatients and 171 episodes were studied. The prevalence of PI episodes was 6% and the cumulative incidence was 2.9% during the first-wave of COVID-19. Risk of acute wounds was four times higher in the COVID-19 patient group (p<0.001). Most common locations were sacrum and heels. Among hospital acquired pressure injuries a significant association was observed between arterial hypertension and diabetes mellitus in patients with COVID-19 diagnosis. Conclusion During the first wave of COVID-19, COVID-19 patients tend to present a higher number of acute wounds, mainly of hospital origin, compared to the profile of the non-COVID group. Diabetes mellitus and arterial hypertension were identified as main associated comorbidities in patients with COVID-19 diagnosis.
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Affiliation(s)
| | - Adela Carpio-Pérez
- Internal Medicine Service, University Hospital of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), Tropical Disease Research Centre of the University of Salamanca (CIETUS), Salamanca, Spain
| | | | - Emilia Ruiz-Antúnez
- Training, Development and Innovation Area, University Hospital of Salamanca, Salamanca, Spain
| | - Ainhoa Nieto-García
- School of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
| | - Montserrat Alonso-Sardón
- Preventive Medicine and Public Health Area, University of Salamanca, Institute for Biomedical Research of Salamanca (IBSAL), Tropical Disease Research Centre of the University of Salamanca (CIETUS), Salamanca, Spain
- * E-mail:
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Bryant RA, Moore ZE, Iyer V. Clinical profile of the SEM Scanner - Modernizing pressure injury care pathways using Sub-Epidermal Moisture (SEM) scanning. Expert Rev Med Devices 2021; 18:833-847. [PMID: 34338565 DOI: 10.1080/17434440.2021.1960505] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Pressure injuries (PIs) are a global health concern. Current PI care standards, including skin tissue assessments (STA) and health care professional (HCP) clinical judgment, diagnose visibly manifested PIs on the skin's surface, i.e. after the damage has already occurred. However, objective assessment of early-stage, non-visible, pressure-induced tissue damage is clinically impossible within the current standard of care. The SEM Scanner is the first device authorized by the Food and Drug Administration (FDA) that addresses this unmet clinical need. AREAS COVERED This review describes the novel sub-epidermal moisture (SEM) scanning technology of the device and summarizes the clinical safety and efficacy data that support the use of the scanner in routine PI care practice. EXPERT OPINION The clinical strategy for developing the SEM Scanner is noteworthy. SEM technology using anatomy-specific data enables HCPs to provide early PI prevention interventions before visible signs of tissue damage develop while the damage is still reversible. When adopted into routine practice, the device identifies an increased risk of developing PIs 5 days (median) earlier than STA. FDA clearance was based on bench studies and data from three foundational trials that demonstrate the diagnostic accuracy of the device algorithm significantly exceeding clinical judgment (p < 0.001).
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Affiliation(s)
- Ruth A Bryant
- Principal Research Scientist/Nursing, President, Association for the Advancement of Wound Care (AAWC), Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Zena Eh Moore
- Director of the Skin Wounds and Trauma (Swat)research Centre, MSc (Leadership in Health Professionals Education), MSc (Wound Healing & Tissue Repair), FFNMRCSI, Professor and Head of the School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Ireland.,Department is School of Medicine, Honorary Visiting Professor, Cardiff University, Cardiff, Wales.,Adjunct Professor, Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, KSA.,Professor, Vakgroep Maatschappelijke Gezondheidkunde, Department of Public Health; Faculteit Geneeskunde En Gezondheidswetenschappen, Faculty of Medicine and Health Sciences, UGent, Ghent University, Belgium.,Department is School of Nursing, Honorary Professor, Lida Institute, Shanghai, China
| | - Vignesh Iyer
- MS Biotechnology and Clinical Lab Sciences, MSc Biotechnology, Senior Manager, Clinical R&D and Medical Affairs, Bruin Biometrics, LLC, Los Angeles, CA
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Healthcare Workers' Experiences and Views of Using Surgical Masks and Respirators, and Their Attitudes on the Sustainability: A Semi-Structured Survey Study during COVID-19. NURSING REPORTS 2021; 11:615-628. [PMID: 34968337 PMCID: PMC8608101 DOI: 10.3390/nursrep11030059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 02/05/2023] Open
Abstract
A universal mask use was instituted in healthcare during COVID-19 pandemic in 2020. The extensive growth in the consumption of surgical masks and respirators brought new challenges. Healthcare workers had to get accustomed to wearing the facemasks continuously, raising concerns on the patient, occupational, and environmental safety. The aim of this study is to describe frontline healthcare workers and other authorities’ views and experiences on continuous use of surgical masks and respirators (facemasks) and their attitudes towards environmental and sustainability issues. A cross-sectional web-based survey was conducted in Finland during the COVID-19 pandemic in autumn 2020. The respondents(N = 120) were recruited via social media, and the data were collected using a purpose-designed questionnaire. Descriptive statistics and inductive content analysis were used to analyze the quantitative data and qualitative data, respectively. The healthcare workers perceived their own and patient safety, and comfortability of facemasks as important, but according to their experiences, these properties were not evident with the current facemasks. They considered protection properties more important than environmental values. However, biodegradability and biobased material were seen as desired properties in facemasks. Based on the results, the current facemasks do not meet users’ expectations well enough. Especially the design, breathability, and sustainability issues should be taken more into account.
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Yap KK, Murali M, Tan Z, Zhou X, Li L, Masen MA. Wax-oil lubricants to reduce the shear between skin and PPE. Sci Rep 2021; 11:11537. [PMID: 34078980 PMCID: PMC8173004 DOI: 10.1038/s41598-021-91119-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
Prolonged use of tight-fitting PPE, e.g., by COVID-19 healthcare workers leads to skin injuries. An important contributor is the shear exerted on the skin due to static friction at the skin-PPE interface. This study aims to develop an optimised wax-oil lubricant that reduces the friction, or shear, in the skin-PPE contact for up to four hours. Lubricants with different wax-oil combinations were prepared using beeswax, paraffin wax, olive oil, and mineral oil. In-vivo friction measurements involving seven participants were conducted by sliding a polydimethylsiloxane ball against the volar forearms to simulate the skin-PPE interface. The maximum static coefficient of friction was measured immediately and four hours after lubricant application. It was found that the coefficient of friction of wax-oil lubricants is mainly governed by the ratio of wax to oil and the thermal stability and morphology of the wax. To maintain long-term lubricity, it is crucial to consider the absorption of oil into the PPE material. The best performing lubricant is a mixture of 20 wt% beeswax, 40 wt% olive oil, and 40 wt% mineral oil, which compared to unlubricated skin, provides 87% (P = 0.0006) and 59% (P = 0.0015) reduction in instantaneous and 4-h coefficient of friction, respectively.
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Affiliation(s)
- Kian Kun Yap
- Department of Mechanical Engineering, Imperial College London, London, UK.
| | - Manoj Murali
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Zhengchu Tan
- Department of Mechanical Engineering, Imperial College London, London, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Xue Zhou
- Department of Mechanical Engineering, Imperial College London, London, UK
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Luli Li
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Marc Arthur Masen
- Department of Mechanical Engineering, Imperial College London, London, UK
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Ramalho ADO, Rosa TDS, Santos VLCDG, Nogueira PC. ACUTE SKIN FAILURE E LESÃO POR PRESSÃO EM PACIENTE COM COVID-19. ESTIMA 2021. [DOI: 10.30886/estima.v19.1007_pt] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objetivo:relatar o caso de um paciente crítico com COVID-19 e mostrar os principais achados relacionados à lesão considerada Acute skin failure (ASF), bem como realizar seu diagnóstico diferencial com lesão por pressão (LP) evitável. Método: estudo observacional do tipo relato de caso, desenvolvido em um hospital de São Paulo, na unidade de terapia intensiva (UTI) exclusiva a pessoas diagnosticadas com COVID-19. Os dados foram coletados de um único paciente, entre os meses de março e setembro de 2020. Resultados: paciente com complicações da COVID-19 evoluiu com lesão de pele, inicialmente definida como LP e posteriormente reclassificada como ASF. Os seguintes achados corroboraram o diagnóstico: ventilação mecânica invasiva prolongada, insuficiências respiratória, renal e cardíaca e sepse de foco respiratório. Além disso, outros fatores agravantes, como o uso de droga vasoativa, instabilidade hemodinâmica com intolerância ao mínimo reposicionamento, jejum prolongado e coagulopatia intravascular disseminada associada à infecção pelo coronavírus. Conclusão: o relato mostra que existem dificuldades para o diagnóstico diferencial entre ASF e LP na prática clínica. Trata-se de conceito novo, sendo fundamental que o profissional de saúde reconheça os principais fatores associados ao aparecimento da ASF, muitos dos quais também estão relacionados ao desenvolvimento das LP, ressaltando a necessidade de análise individualizada dessas lesões, e garantia da implementação de intervenções adequadas para prevenção e tratamento.
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Ramalho ADO, Rosa TDS, Santos VLCDG, Nogueira PC. ACUTE SKIN FAILURE AND PRESSURE INJURY IN THE PATIENT WITH COVID-19. ESTIMA 2021. [DOI: 10.30886/estima.v19.1007_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective:report the case of a critical patient with COVID-19 and show the main findings related to the injury considered acute skin failure (ASF), as well as perform his differential diagnosis with preventable pressure injury (PI). Method: observational, longitudinal, case report type study, developed in a hospital in São Paulo, in the intensive care unit (ICU) exclusively for people diagnosed with COVID-19. Data were collected from a single patient between March and September 2020. Results: A patient with complications from COVID-19 developed a skin lesion, initially defined as PI and later reclassified as ASF. The following findings corroborated the diagnosis: prolonged invasive mechanical ventilation, respiratory, renal and cardiac insufficiency and sepsis of respiratory focus. In addition, other aggravating factors, such as the use of vasoactive drugs, hemodynamic instability with intolerance to minimal repositioning, prolonged fasting and disseminated intravascular coagulopathy associated with coronavirus infection. Conclusion: the report shows that there are difficulties for the differential diagnosis between ASF and PI in clinical practice. This is a new concept, and it is essential that health professionals recognize the main factors associated with the appearance of ASF, many of which are also related to the development of PI, highlighting the need for individualized analysis of these injuries, and ensuring the implementation of interventions for prevention and treatment.
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