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Infection Prevention: Prevent Pressure Injuries Caused by PPE
Protect your staff's skin from the harmful effects of protective gear.
Joe Paone | Senior Editor
Publish Date: July 1, 2021   |  Tags:   Infection Prevention Staff Safety
Pressure Injury
UNDER PRESSURE After working 13 hours in an Italian ICU at the beginning of the pandemic, Nicola Sgarbi, MD, removed his PPE and posted this alarming selfie.   |   Facebook/Nicola Sgarbi

At the onset of the pandemic, William Padula, PhD, MS, MSc, saw something distressing among the frontline doctors and nurses speaking on TV. "They had deep dark cuts and bruises all along their forehead, underneath their eyes and on the bridges of their nose," says Dr. Padula, an assistant professor of pharmaceutical and health economics at the University of Southern California and president of the National Pressure Injury Advisory Panel (NPIAP). "It was right there in plain sight that pressure injuries were highly prevalent in medical workers donning PPE for 12- to 18-hour shifts."

The phenomenon is a danger not just in terms of pressure injury development, but also infection control and personal safety. "In addition to potential for scarring, open cuts and wounds caused by PPE make providers more susceptible to infections," says Dr. Padula.

Some providers might think this is old news with the pandemic hopefully nearly over and all-day mask-wearing requirements coming to an end. However, the Association for Professionals in Infection Control and Epidemiology (APIC) says the CDC's updated Interim Public Health Recommendations for Fully Vaccinated People, which says they no longer have to wear masks, do not apply to healthcare settings.

"Healthcare facilities should continue to follow all current COVID-19 infection prevention and control recommendations, including those addressing the use of PPE to protect themselves and others from COVID-19," states APIC.

Given that the end to maximum PPE usage still isn't in sight for healthcare facilities, how can you protect against possible pressure injuries to yourself and your staff?

Dr. Padula says the pandemic led NPIAP to renew the industry's focus on its guidelines for pressure injury prevention, and how they overlap with PPE donnage. That led to a peer-reviewed position paper in the Journal of Clinical Nursing with recommendations based only on strong, clear evidence. NPIAP offers a downloadable poster of the guidelines.

NPIAP recommends that providers offload pressure and protect skin by using films, moisturizers and other technology before donning PPE. The five to 10 minutes needed to do this obviously is a rate-limiting step, says Dr. Padula, so have necessary products on hand and easily available. NPIAP also recommends providers remove their masks or eye protection every couple hours for five to 15 minutes to alleviate pressure.

There are different pressure points produced by surgical masks versus N95 masks. "On a surgical mask, it's on the back of your ears," says Dr. Padula. "On an N95 mask, it's heavy pressure on the bridge of your nose."

He has personally purchased gadgets on Amazon that tie surgical mask ear straps together to alleviate pressure. "It's a simple solution," he says, adding, "If you're stuck wearing a mask with ear loops, you need to take it off and massage the back of your ears every hour or so to let blood flow back into that space, because there's not even a layer of fat. It's just skin on cartilage."

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