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Pressure ulcers

Update to device-related pressure ulcers: secure prevention. Covid-19, face masks and skin damage

02 May 2020
Education
02 May 2020
Volume 4 · Issue 2

Abstract

The 2019 novel coronavirus disease (COVID-19) pandemic has brought the effects of device-related pressure ulcers (DRPU) into sharp focus. With the increased use of personal protective equipment (PPE), including face masks, continuous positive airway pressure (CAPP) masks and other devices, the incidence of DRPUs among health professionals and patients alike has risen starkly. As such, the Journal of Wound Care (JWC) consensus document, Device-related pressure ulcers: SECURE prevention, published in February 2020, is more relevant than ever. To help support patients and frontline health professionals, JWC is republishing the consensus in a digital format, along with a new introductory article outlining the DRPU risks posed by PPE and other medical devices used by patients and health professionals during the pandemic, and how the skin damage can be avoided. The aim is to provide frontline staff with a clear, simple strategy on how to prevent the risk of personal skin damage and/or DRPU during the pandemic, as well as point them in the direction of more in-depth guidance on long-term strategies for prevention, for both themselves and patients.

Until now, device-related pressure ulcers (DRPUs) and measures to prevent them have been concerned with the effect of devices on patients. However, in the 2019 novel coronavirus disease (COVID-19) era, things have changed and it is now health professionals who require help in preventing skin damage and DRPUs. The COVID-19 pandemic has brought the effects of DRPUs into sharp focus. With such a considerable global rise in the numbers of patients requiring intensive care and the increased use of prone positioning to treat acute respiratory distress syndrome (ARDS), the incidence of DRPU is expected to increase. In addition, a new and common type of DRPU associated with the pandemic appeared among medical workers is that of facial injuries caused by personal protective equipment (PPE). These injuries are primarily caused by medical face masks and goggles, although reports are now emerging of PPE-induced skin damage in other areas including the armpit, groin and extremities.1 The same study, by Jiang et al. published 27 April 2020, reported the overall prevalence of skin injuries caused by PPE in medical staff was 42.8% (95% confidence interval (CI)41.30–44.30%), with three distinct types reported: DRPU; moist-associated skin damage (MASD); and skin tears. Furthermore, logistic regression indicated that sweating (95%CI for odds ratio (OR) 87.52–163.11), daily wearing time (95% CI for OR 1.61–3.21), being male (95% CI for OR 1.11–2.13) and wearing grade 3 PPE (95% CI for OR 1.08–2.01) were associated with these skin injuries.

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acute respiratory distress syndrome
COVID-19
device-related pressure ulcer
face masks
personal protective equipment
skin damage