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      Descripción de una intervención para prevenir lesiones cutáneas por presión provocadas por los equipos de protección personal (EPIs) durante la atención de pacientes con COVID-19 Translated title: Description of an intervention to prevent pressure-induced skin lesions caused by personal protective equipment (PPE) during the care of patients with COVID-19

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          Abstract

          Resumen Objetivos: Describir los resultados de una estrategia diseñada para evitar lesiones cutáneas por presión relacionadas con la utilización de los equipos de protección individual (EPIs). Metodología: Estudio descriptivo observacional prospectivo realizado entre marzo y junio de 2020 en profesionales del Parc de Salut Mar (PSMAR) que utilizaron EPIs en áreas de pacientes diagnosticados de COVID-19. Un servicio de vigilancia multidisciplinar se activó con el fin de realizar una detección precoz. Se suministró de forma individualizada a 1044 profesionales materiales para prevención de lesiones por presión, fricción y humedad de los EPIs sobre la piel de la cara. Resultados: De todos los profesionales, 32 fueron citados para una valoración presencial por lesiones: 6 presentaron úlceras por presión en estadios III y IV, 24 dermatitis, foliculitis y eczemas. La tasa de presentación de úlceras fue del 0,57% y la de dermatitis del 2,30% de la población de estudio. Conclusión: Los resultados de la aplicación de las medidas especificadas indican que han sido eficaces para prevenir úlceras por presión en la región de la cara provocadas por los EPIs. La adopción de medidas de prevención no solo para prevenir ulceras por presión sino para la prevención de dermatitis se hacen imprescindibles en situaciones en las que se requiere el uso continuado de EPIs en la región de la cara.

          Translated abstract

          Abstract Objective: To describe a strategy designed to avoid pressure-related skin lesions related to the use of personal protective equipment (PPE). Methods: This was a prospective descriptive observational study. Study population: healthcare professionals at the Parc Salut Mar (Barcelona) who used PPE for protection against COVID-19 between March 30 and June 15, 2020. Intervention: Each professional was provided with an individual kit to prevent PPE-induced lesions, friction, or moisture. A multidisciplinary surveillance team was deployed for the early detection of these adverse events. Results: Individual kits were provided to 1044 professionals, 32 of whom were scheduled for in-person medical assessments. Six participants (0.57%) developed Stage III or IV pressure ulcers, 24 (2.3%) had dermatitis, folliculitis, eczema and two participants did not show for their appointments. The overall rate of pressure ulcers was 0.57%; for dermatitis it was 2.3%. Conclusions: The use of preventive measures appears to be effective in preventing facial pressure ulcers induced by EPIs among healthcare professionals. Our resultsalso underscore the importance of expanding preventive measures to include not only pressure ulcers but also dermatitis.

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          Skin damage among health care workers managing coronavirus disease-2019

          To the Editor: Since the outbreak of coronavirus disease-2019 (COVID-19) in December 2019, more than 200,000 health care workers from all over China have been participating in the fight against this highly contagious disease in Hubei province, which is the center of infection in China. Skin damage caused by enhanced infection-prevention measures among health care workers, which could reduce their enthusiasm for overloaded work and make them anxious, has been reported frequently. Previous studies have revealed that hand eczema is quite common in health care workers, 1 , 2 and the risk factors include frequent hand hygiene and wearing gloves for a long time. 3 , 4 Considering the frequent hand hygiene and long-time wearing of tertiary protective devices (N95 mask, goggles, face shield, and double layers of gloves) among health care workers during the epidemic period of COVID-19, we aimed to estimate the prevalence, clinical features, and risk factors of this skin damage among them. From January to February 2020, self-administered online questionnaires were distributed to 700 individuals, consisting of physicians and nurses who worked in the designated departments of tertiary hospitals in Hubei, China. The questionnaire included questions about the condition of skin damage and the frequency or duration of several infection-prevention measures (Supplemental Material 1, available via Mendeley at https://data.mendeley.com/datasets/zknvry83v5/2). Finally, 542 individuals (Supplemental Material 2) completed the study (response rate, 77.4%), with 71.4% (387 of 542) working in isolation wards and 28.6% (155 of 542) working in fever clinics. The general prevalence rate of skin damage caused by enhanced infection-prevention measures was 97.0% (526 of 542) among first-line health care workers. The affected sites included the nasal bridge, hands, cheek, and forehead, with the nasal bridge the most commonly affected (83.1%). Among a series of symptoms and signs, dryness/tightness and desquamation were the most common symptom (70.3%) and sign (62.2%), respectively (Table I ). The health care workers who wore some medical devices more than 6 hours had higher risks of skin damage in corresponding sites than those who did for less time (N95 masks: odds ratio [OR], 2.02; 95% confidence interval [CI], 1.35-3.01; P  10 times daily) hand hygiene could increase the risk of hand skin damage (OR, 2.17; 95% CI, 1.38-3.43; P  6 h/d 317 (58.5) Cheek: 259 (81.7) 2.02 1.35-3.01 6 h/d 265 (58.8) Nasal bridge: 233 (87.9) 2.32 1.41-3.83 6 h/d 157 (59.2) Forehead: 92 (58.6) 1.52 0.93-2.50 .66 Gloves 113∗ ≤6 h/d 52 (46.0) Hands: 29 (55.8) 1 [Ref] >6 h/d 61 (54.0) Hands: 39 (63.9) 1.41 0.66-3.00 .44 321† ≤6 h/d 131 (40.8) Hands: 100 (76.3) 1 [Ref] >6 h/d 190 (59.2) Hands: 146 (76.8) 1.03 0.61-1.74 >.99 Hand hygiene 434 ≤10 times/d 113 (26.0) Hands: 68 (60.2) 1 [Ref] >10 times/d 321 (74.0) Hands: 246 (76.6) 2.17 1.38-3.43 10 times/d. Our study has some limitations. Firstly, we only studied 1 site with a single exposure factor, but some sites could be related to more than 1 factor. The nasal bridge, for example, could be compressed by the N95 mask and goggles simultaneously, although goggles were the main factor. Secondly, possible risk factors such as participants wearing the N95 mask after work in daily life were not included. In conclusion, our study demonstrated that the prevalence of skin damage of first-line health care workers was very high. Moreover, we found that longer exposure time was a significant risk factor, which highlights that the working time of first-line staff should be arranged reasonably. Besides, prophylactic dressings could be considered to alleviate the device-related pressure injuries, according to a prior study. 5
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            Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome – a descriptive study in Singapore

            Severe acute respiratory syndrome (SARS) was first recognized in February 2003. It is the first severe and readily transmissible new disease to emerge in the 21st century. Healthcare workers in affected countries were exposed to the regular use of personal protective equipment (PPE) such as the N95 mask, gloves, and gowns. Our aim was to study the prevalence of adverse skin reactions to PPE among healthcare workers in Singapore during the SARS outbreak. Healthcare staff in the National Skin Centre and Tan Tock Seng Hospital were surveyed using questionnaires. Of those asked to participate, 322 (94.7%) agreed. 14.3% of the respondents were doctors, 73.0% nurses, and 12.7% other ancillary staff. Mean age of respondents was 32.4 years, with the majority being women (85.7%) and Chinese (53.7%). 109 (35.5%) of the 307 staff who used masks regularly reported acne (59.6%), facial itch (51.4%), and rash (35.8%) from N95 mask use. 64 (21.4%) of the 299 who used gloves regularly reported dry skin (73.4%), itch (56.3%), and rash (37.5%). The use of PPE is associated with high rates of adverse skin reactions. There is a need to find suitable alternatives for affected staff and to encourage awareness among staff of the role of dermatologists in their care.
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              The adverse skin reactions of health care workers using personal protective equipment for COVID-19

              Abstract In December 2019, a new coronavirus was found in Wuhan, Hubei Province, China, and spread rapidly throughout the country, attracting global attention. On February 11, the World Health Organization (WHO) officially named the disease caused by 2019-nCoV coronavirus disease 2019 (COVID-19). With the increasing number of cases, health care workers (HCWs) from all over China volunteered to work in Hubei Province. Because of the strong infectivity of COVID-19, HCWs need to wear personal protective equipment (PPE), such as N95 masks, latex gloves, and protective clothing. Due to the long-term use of PPE, many adverse skin reactions may occur. Therefore, the purpose of this study is to explore the adverse skin reactions among HCWs using PPE. Questionnaires were used for the research; a quantitative study was carried out to determine the incidence of adverse skin reactions among HCWs using PPE. A total of 61 valid questionnaires were collected. The most common adverse skin reactions among HCWs wearing N95 masks were nasal bridge scarring (68.9%) and facial itching (27.9%). The most common adverse skin reactions among HCWs wearing latex gloves were dry skin (55.7%), itching (31.2%), and rash (23.0%). The most common adverse skin reactions among HCWs wearing protective clothing were dry skin (36.1%) and itching (34.4%). When most HCWs wear PPE for a long period of time, they will experience adverse skin reactions. The incidence of adverse skin reactions to the N95 mask was 95.1%, that to latex gloves was 88.5%, and that to protective clothing was 60.7%.
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                Author and article information

                Journal
                aprl
                Archivos de Prevención de Riesgos Laborales
                Arch Prev Riesgos Labor
                Societat Catalana de Salut Laboral y Asociación de Medicina del Trabajo de la Comunidad Valenciana (Barcelona, Barcelona, Spain )
                1578-2549
                September 2021
                : 24
                : 3
                : 252-262
                Affiliations
                [1] Barcelona orgnameParc de Salut Mar orgdiv1Dirección de Enfermería España
                [2] Barcelona orgnameParc de Salut Mar orgdiv1Servicio de Metodología, Calidad y soporte a la Investigación Enfermera España
                [5] Barcelona Cataluña orgnameUniversitat Autónoma de Barcelona Spain
                [3] Barcelona orgnameParc de Salut Mar orgdiv1Grup d'investigació d' Epidemiologia i Avaluació, IMIM España
                [4] Barcelona orgnameParc de Salut Mar orgdiv1Servicio de Dermatología España
                Article
                S1578-25492021000300252 S1578-2549(21)02400300252
                10.12961/aprl.2021.24.03.03
                d76b73b6-8e55-419a-9b7b-835f7c01f4b7

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 17 May 2021
                : 25 March 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 19, Pages: 11
                Product

                SciELO Spain

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                úlceras por presión,COVID-19, salud laboral,prevención de riesgos laborales,Occupational injury,personal protective equipment,covid-19, pressure injury,prevention,equipos de protección personal

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