Guarding skin under PPE: Mechanistic insights and technological innovations

Abstract

In the presence of diseases transmitted through respiratory droplets and direct contact, healthcare workers (HCWs) necessitate the use of personal protective equipment (PPE). For optimal safety, PPE should securely conform to the skin during extended wear. However, conventional PPE often lacks adequate air permeability and hygroscopicity, trapping heat and moisture emitted by the body within the enclosure. Such a hot and humid internal environment can induce skin damage, such as erythema, rash, pruritus, and itching among others, leading to microbial growth on the skin surface, the production of inflammatory mediators at the wound site and an increased risk of infection. This review strives to comprehensively elucidate the fundamental mechanisms triggering adverse skin reactions and their resultant manifestations. Furthermore, we explore recent advancements aimed at inhibiting these mechanisms to effectively mitigate the occurrence of skin lesions.

Keywords: personal protective equipment (PPE); skin damage; skin reactions; technological advancements.

FIGURE 1

The fundamental mechanisms behind skin reactions the microclimate primarily encompasses the micro‐environment created by elevated temperature and air humidity. The presence of such microclimate can significantly diminish the comfort experienced by individuals and give rise to skin adverse reactions, including acne and seborrheic dermatitis. Consequently, both physical well‐being and work performance may be adversely impacted. In a general sense, the mechanisms behind skin reactions subsequent to the utilization of PEE encompass three primary facets: (i) The dominant bacteria on the skin were Staphylococcus spp., Xanthomonas spp., and Cutibacterium spp.; (ii) Various forms of physical injury can induce skin impairment, predominantly involving pressure, friction, and shear forces; (iii) The hydration level will increase (with relative humidity typically surpassing 60%). Wearing PPE also lead to abundant sebum secretion and an elevation in the skin's pH value. (By Figdraw). PPE, personal protective equipment.

FIGURE 2

Functions and mechanisms of various other preventive measures (By Figdraw) (i) Hygroscopic composite films can enhance PPE by regulating humidity, improving comfort and durability. Various dehumidification methods exist, and membrane dehumidification is a suitable choice for PPE; (ii) Hygroscopic composite films can enhance PPE by regulating humidity, improving comfort and durability. Various dehumidification methods exist, and membrane dehumidification is a suitable choice for PPE; (iii) Prophylactic dressings (e.g., hydrogel, foam, hydrocolloid dressings) prevent pressure injuries, reduce friction, and shield against irritants when using PPE; (iv) In a daily skin‐care routine, soaps cleanse the skin, humectants like glycerin retain moisture, and emollients such as ceramide protect against irritants. These essential steps promote skin health and resilience, particularly in managing PPE‐related damage. PPE, personal protective equipment.