Protective equipment-related pressure ulcers in healthcare workers during COVID-19 pandemic: A systematic review

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During the height of the COVID pandemic my colleagues and I at the RCSI Skin Wounds and Trauma Research Centre were involved in two projects that involved preventing facial pressure ulcers, caused by PPE, in frontline COVID staff.

This paper added further fuel to what was a global phenomenon, and one we must take learnings from to avoid a problem that is largely preventable.

The clinical reality during COVID was that frontline staff had to wear PPE for their own safety. This meant that the use of PPE across health services increased dramatically with prolonged usage time, thus increasing the risk for PPE related pressure ulcers in healthcare workers.

The systematic review presented in this paper examined pressure ulcers that occurred in healthcare staff due to the use of PPE during the pandemic and the precautions taken to prevent these injuries.

An evidence based search was undertaken and 17 studies emerged meeting the inclusion criteria, with a sample of over 24,000 healthcare workers. The incidence of PPE related pressure ulcers was found to be between 30% and 92.8%, with grade 1 pressure ulcers being the most common. Additionally, the incidence of skin problems other than PPE related pressure ulcers such as itching, redness and dry skin was found to be between 42.8–88.1%. PPE related pressure ulcers and other skin problems were more frequent over the nose (nasal bone/nasal bridge), ears, forehead and cheeks.

The most frequent identified risk factors that played a role in the development of PPE related skin problems were longer use of PPE and sweating. In terms of preventing PPE related ulcers, several dressing applications were found to be effective, particularly in relation to the prevention of facial pressure ulcers.

Most of the studies included in this systematic review were cross sectional and descriptive studies using online surveys. Healthcare professionals were asked to self-report PPE related pressure ulcers or skin problems. This is a potential limitation and expert validation is something that could happen in future studies.