Skin Barrier Damage due to Prolonged Mask Use among Healthcare Workers and the General Population during the COVID-19 Pandemic: A Prospective Cross-Sectional Survey in China

Impact of infection prevention measures on the occurrence of cutaneous lesions and the quality of life of frontline and non-frontline healthcare workers: A multicentre cross-sectional study

Background

Infection prevention measures are crucial to prevent contamination among frontline healthcare workers (FL-HCWs) and non-frontline healthcare workers (NFL-HCWs). However, these measures can lead to skin lesions, potentially affecting their quality of life.

Objectives

Determine the prevalence of skin lesions caused by infection prevention measures and assess the impact of skin lesions on the quality of life.

Methods

A cross-sectional study was conducted, utilizing a self-administered questionnaire covering demographic and occupational information, self-reported skin lesions, and the Dermatology Life Quality Index (DLQI) for healthcare workers (HCWs) from three medical centres.

Results

Out of the 190 FL-HCWs and 199 NFL-HCWs surveyed, 37.2% reported skin lesions. Female and FL-HCWs exhibited a higher occurrence of skin lesions. Prolonged use of masks was significantly associated with facial skin lesions. While the use of personal protective equipment and hand hygiene had little to no effect on the Dermatology Life Quality Index (DLQI) for 80.7% of healthcare workers (HCWs) with skin lesions, those with facial skin lesions, papules, or a history of any skin lesions, as well as those who more frequently washed their hands, showed a more altered DLQI.

Conclusions

FL-HCWs had more skin symptoms than NFL-HCWs, but these issues were generally not severe and had minimal impact on overall quality of life.

Mask wearing impacts skin barrier function and microbiome profile in sensitive skin

Mask-wearing behavior, common in the post-COVID-19 era, raises concerns for sensitive skin. This split-face study investigated mask-related changes in skin barrier function and microbiome composition among 30 female volunteers with sensitive skin and assessed the mitigating effects of a moisturizer containing biological lipids and probiotics. Skin physiological indicators (transepidermal water loss, erythema index, stratum corneum hydration, pH, temperature) of masked and unmasked areas were collected at baseline, after three hours of mask-wearing, post-tape stripping, and after 24 h, respectively. Microbiome samples collected from the masked areas before and after wearing a medical mask were analyzed with bioinformatics methods. Mask-wearing significantly weakened barrier function in both masked and adjacent unmasked areas, while reducing bacterial diversity. It was also associated with an increase in Cutibacterium (P = 0.110) and decreases in Streptococcus (P = 0.032) and Prevotella (P = 0.026) abundance. Moisturizer application prior to mask-wearing significantly reduced transepidermal water loss and erythema (both P < 0.001) and further improved erythema after 24 h (P = 0.048). These findings demonstrate that mask-wearing can disrupt the skin barrier and microbiome in individuals with sensitive skin and applying a moisturizer beforehand can mitigate mask-related discomforts by aiding barrier repair and reducing sensitivity.

Challenges and Solutions to Patient Safety During a Pandemic

When exploring the realm of Patient Safety in the context of a COVID-19 global pandemic, the traditional methods of assessment may not be sufficient. This was a crisis that could not be isolated to intensive care units or the hospital environment. In addition to patient safety, one must consider the safety of health care providers and others. Understanding human behavior when faced with a novel disease such as COVID-19 may help prepare for the future when society may once again face a public health crisis together.

Contact dermatitis caused by prevention measures during the COVID-19 pandemic: a narrative review

Introduction

During the outbreak of Coronavirus disease 2019 (COVID-19), health care workers wore personal protective equipment including masks, gloves and goggles for a long time. In order to reduce the transmission routes of the virus, public places were sprayed with disinfectant. Moreover, the body, hands and clothing were frequently disinfected and washed for hygiene purposes. Studies have shown that these practices could easily irritate the skin and damage the skin barrier. Long-term irritation or exposure to allergens may lead to the occurrence of contact dermatitis (CD).

Methods

Subject headings were searched via the National Library of Medicine (PubMed) and web of science databases: COVID-19; contact dermatitis; adverse skin reaction; PPE; dermatitis; mask; glory; hand hygiene, disinfection; face shield; goggle; protect cloth. A total of 246 and 646 articles were retrieved from the two databases, respectively. 402 articles remained after removing duplicates. Reviews, non-English articles, articles that could not be accessed to read or did not conform to our topic were excluded. Finally, a total of 32 cross-sectional studies, 9 case reports and 2 randomized controlled trials were included.

Discussion

This article reviews reports of CD caused by various prevention and hygiene measures during the COVID-19 pandemic. The amount of skin damage caused by COVID-19 prevention measures could be decreased by improved education about skin management.

Impact of prolonged PPE use on Canadian health professionals

AIM

To explore the impact that prolonged use of personal protective equipment (PPE) has on the skin integrity of Canadian health professionals.

METHOD

A descriptive, pan-Canadian, cross-sectional, online survey was carried out to explore the type and prevalence of PPE-related skin injury among Canadian health professionals. Convenience sampling was used to disseminate the online survey link to health professionals.

RESULTS

There were responses from 757 health professionals. Masks worn included surgical masks (90%), a combination of surgical or N95/KN95 masks (7.7%) and an N95/KN95 mask alone (2.7%). Responses showed 84.6% of providers always wear a mask while at work with 38.5% wearing the same mask all shift; 90% of participants wore protective eye wear. Complications included soreness or pressure injuries behind the ears (70%), new or worsening acne (52%), a runny nose or sneezing (45%), itching (39%), and dry skin (37%). Hand issues included dry skin (53%), red skin (30%), itching (26%), broken skin (20%), rash (16%), and dermatitis (11%) - 51% of respondents did not moisturise their hands. Complications related to gown use included itching (6%), moisture-associated skin damage (5.5%), feeling claustrophobic (4.5%), and new or worsening acne (3%). Increased perspiration due to PPE was experienced in 87.5% of respondents. Some 43% of respondents noted their mental health became worse due to wearing PPE for prolonged periods.

CONCLUSION

These findings should be used in the development of guidelines to prevent and manage PPE-related skin injuries among health professionals. Education for professionals should focus on skin protection, prevention of PPE-related skin complications and support for mental health issues.