Personal protective equipment and adverse dermatological reactions among healthcare workers: Survey observations from the COVID-19 pandemic

Abstract

The pandemic of the 2019 novel coronavirus disease (COVID-19) has caused an unprecedented mobilization of the United States' healthcare workforce. In addition to working extended hours under increased duress, healthcare professionals (HCP) of all stations have been making use of various types of personal protective equipment (PPE) with greatly increased frequency and duration. Current data regarding adverse skin reactions as a possible consequence of PPE use are, particularly in the United States, largely insufficient for policy-makers to make informed decisions regarding daily PPE use among HCP.The research vehicle employed by this study is a cross-sectional 25-item survey distributed via email to workers currently employed by a five-hospital system in southcentral Kentucky. This survey was used to collect information from hospital workers of all professional roles about their experiences during the COVID-19 pandemic, focusing on reports of adverse dermatological reactions and associated risk factors.Out of 879 respondents, 54.4% reported some type of skin irritation reaction. Skin irritation was significantly more prevalent among medical and medical support staff than non-medical hospital workers, with the highest prevalence among Certified Nurse Assistant (CNAs). Among clinical workers, those in dedicated COVID-19 units reported the highest prevalence of adverse skin reaction. The most common complaint was dryness/scaling of the skin (306 out of 439, 69.7%), and the most common location was the facial cheeks (305 out of 516, 59.1%). Among those who reported skin irritation, the average self-reported severity of skin reaction (on a scale of 1-5) was 2.00 ± 0.05, and the mean total days of skin reaction per month was 11.70 ± 0.39 days. Total days of irritation per month was found to be significantly related to "total days of PPE use per month," "hours of PPE use per day," "frequency of hand washing," and "use of disinfecting UV irradiation." Severity of skin reaction was found to be significantly related to "hours per day of PPE use," "consecutive days of PPE use," and "female sex."Clinical workers that put in the most face-to-face time with patients, and those in dedicated COVID-19 units, had the highest risk of adverse skin reaction. Overall, skin reactions were found to be mild, even in those hospital workers with the heaviest PPE use. Because the widespread and consistent use of facial masks in public settings has become a key tool in our protracted struggle with SARS-CoV-2, these findings may help to ameliorate concerns that everyday facial mask and/or other PPE usage contributes to significant dermatologic morbidity among both medical professionals and public citizens.

Figure 1

Respondent by Professional Role.

Figure 2

Respondent by Hospital Unit.

Figure 3

Respondent by Age.

Figure 4

Respondent by Sex.