Gefen A, Ousey K. Update to device-related pressure ulcers: SECURE prevention. COVID-19, face masks and skin damage. J Wound Care. 2020; 29:(5)245-259

Gefen A, Alves P, Cipriandi G An international consensus on device-related pressure ulcers: SECURE prevention. Br J Nurs. 2020; 29:(5)S36-S37

Jiang Q, Song S, Zhou J The prevalence, characteristics, and prevention status of skin injury caused by personal protective equipment among medical staff in fighting COVID-19: a multicenter, cross-sectional study. Adv Wound Care. 2020;

COVID-19 infections may result in red or purplish patches on fingers and toes. (accessed 2 May 2 2020)

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The skin you were in…the impact of Covid-19 on patient and provider skin

02 May 2020
Volume 4 · Issue 2


Kara S Couch, MS, CRNP, CWS, CWCN-AP, Wound Healing and Limb Preservation Center, George Washington University Hospital and Catherine T Milne, MSN, APRN, ANP/ACNS-BCC, CWOCN-AP, Connecticut Clinical Nursing Associates, describe the skin issues so far observed during the COVID-19 pandemic in patients as well as those faced by health professionals.

COVID-19 has profoundly impacted healthcare provider patient management as well as patient self-care. For those of us who specialise in wounds, we find ourselves faced with managing both patients and our colleagues as this pandemic impacts the skin health in both populations.

While amid the pandemic, we cannot fully appreciate each and every thing reported as an adverse skin event to determine its relationship to COVID-19. We will need in depth record reviews, aggregate national and international data and analysis of that data to determine this. It will be the focus of much research in the months and years ahead. Retrospective analysis will be challenging as there is no consistent documentation method globally.

New skin alteration phenomena are identified in this crisis. Professor Amit Gefen and Professor Karen Ousey added an unforeseen but necessary update onto the international consensus statement on device-related pressure ulcers (DRPU)1,2 republished in this issue. As noted in the consensus statement, the majority of DRPU (68%) are associated with respiratory devices. The prevalence and severity of DRPU are also higher in an ICU setting when compared with general wards. When combined with an increase in prone positioning for treatment of adult respiratory distress syndrome (ARDS), patients suffering from COVID-19 are likely to suffer from additional pressure ulcers (PU). Understanding the complex relationships between tissue deformation, tissue tolerance and skin moisture with device design and materials help identify issues for further research and ultimately skin protection. The sooner the better for all involved.

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