Prolonged Use of Protective Masks Induced Facial Skin Injury in Primary Healthcare Workers during COVID-19 Pandemic: A Systematic Review
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COVID-19 transmission necessitates health workers to use personal protective equipment (PPE), especially protective masks when delivering medical services. Long-term use of protective masks might cause facial skin injuries. Our study aims to provide a systematic review to explore the phenomenon and incidence of protective masks induced facial skin injuries in primary healthcare workers. This systematic review was created by obtaining articles from the PubMed database and the Cochrane library from 2020 to 2021, using the keywords "Face skin injury," "Wearing protective masks for a long time," and "Wearing protective masks and facial skin disorders." Inclusion criteria were studies that fully report the phenomenon of wearing protective masks and the incidence of facial skin injuries. One hundred and sixty-eight studies were obtained, but only 14 articles matched the inclusion criteria with more than 10,430 participants from different countries that covered various characteristics of facial skin injuries in primary healthcare workers. The findings obtained dominant characteristics of health workers who experienced facial skin injuries: women, N95 masks, and daily N95 coverage for more than 6 hours (p<0.05). Facial skin injuries are often seen after using protective face masks, as it is used for an extended period as part of a defensive effort during work. Therefore, measures that protect health workers from COVID-19 and prevent health workers from potential injuries of protective masks must be taken into account.
World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report - 41 [Internet]. 2019 [cited 2021 Aug 10]. Available from: https://www.who.int/indonesia/news/novel-coronavirus/situation-reports
World Health Organization. Health worker exposure risk assessment and management in the context of COVID-19 virus. [Internet]. 2020 [cited 2021 Aug 10]. Available from: https://www.who.int/publications/i/item/10665-336265
Tang J, Zhang S, Chen Q, Li W, Yang J. Risk factors for facial pressure sore of healthcare workers during the outbreak of COVID"19. International wound journal. 2020;17(6):2028.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Moher D. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. Journal of clinical epidemiology. 2021;134:103-112.
Jiang Q, Song S, Zhou J, Liu Y, Chen A, Bai Y, Wang J, Jiang Z, Zhang Y, Liu H, Hua 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. Advances in wound care. 2020;9(7):357-364.
Battista RA, Ferraro M, Piccioni LO, Malzanni GE, Bussi M. Personal Protective Equipment (PPE) in COVID 19 pandemic: related symptoms and adverse reactions in healthcare workers and general population. Journal of occupational and environmental medicine. 2021;63(2):e80.
Abiakam N, Worsley P, Jayabal H, Mitchell K, Jones M, Fletcher J, Spratt F, Bader D. Personal protective equipment related skin reactions in healthcare professionals during COVID"19. International Wound Journal. 2021;18(3):312-322.
Ippolito M, Ramanan M, Bellina D, Catalisano G, Iozzo P, Di Guardo A, Moscarelli A, Grasselli G, Giarratano A, Bassetti M, Tabah A. Personal protective equipment use by healthcare workers in intensive care unit during the early phase of COVID-19 pandemic in Italy: a secondary analysis of the PPE-SAFE survey. Therapeutic advances in infectious disease. 2021;8:2049936121998562.
Han HS, Shin SH, Park JW, Li K, Kim BJ, Yoo KH. Changes in skin characteristics after using respiratory protective equipment (medical masks and respirators) in the COVID"19 pandemic among healthcare workers. Contact Dermatitis. 2021;85(2):225-232.
Choi J, Shin TG, Park JE, Lee GT, Kim YM, Lee SA, Kim S, Hwang NY, Hwang SY. Impact of personal protective equipment on the first-pass success of endotracheal intubation in the ed: A propensity-score-matching analysis. Journal of clinical medicine. 2021;10(5):1060.
Uthayakumar AK, Panagou E, Manam S, Schauer A, Veraitch O, Walker S, Edmonds E, Crawley J, Martyn-Simmons C. PPE-associated dermatoses: effect on work and wellbeing. Future Healthcare Journal. 2021;8(1):e67.
Uthayakumar AK, Panagou E, Manam S, Schauer A, Veraitch O, Walker S, Edmonds E, Crawley J, Martyn-Simmons C. PPE-associated dermatoses: effect on work and wellbeing. Future Healthcare Journal. 2021;8(1):e67.
Techasatian L, Lebsing S, Uppala R, Thaowandee W, Chaiyarit J, Supakunpinyo C, Panombualert S, Mairiang D, Saengnipanthkul S, Wichajarn K, Kiatchoosakun P. The effects of the face mask on the skin underneath: a prospective survey during the COVID-19 pandemic. Journal of primary care & community health. 2020;11:2150132720966167.
Singh M, Pawar M, Bothra A, Maheshwari A, Dubey V, Tiwari A, Kelati A. Personal protective equipment induced facial dermatoses in healthcare workers managing Coronavirus disease 2019. Journal of the European Academy of Dermatology and Venereology. 2020.
Coelho MD, Cavalcante VM, Moraes JT, Menezes LC, Figueiríªdo SV, Branco MF, Alexandre SG. Pressure injury related to the use of personal protective equipment in COVID-19 pandemic. Revista Brasileira de Enfermagem. 2020;73.
Yuan L, Chen S, Xu Y. Donning and doffing of personal protective equipment protocol and key points of nursing care for patients with COVID-19 in ICU. Stroke and vascular neurology. 2020;5(3).
Shanshal SA, Al-Qazaz HK. Knowledge and Practice of Cement Factory Workers in Relation to Respiratory Symptoms: A Cross-Sectional Study. Systematic Reviews in Pharmacy. 2020;11(6):864-870.
Christopher PM, Roren RS, Tania C, Jayadi NN, Cucunawangsih C. Adverse skin reactions to personal protective equipment among health-care workers during COVID-19 pandemic: a multicenter cross-sectional study in Indonesia. International Journal of Dermatology and Venereology. 2020;3(04):211-218.
Tabah A, Ramanan M, Laupland KB, Buetti N, Cortegiani A, Mellinghoff J, Morris AC, Camporota L, Zappella N, Elhadi M, Povoa P. Personal protective equipment and intensive care unit healthcare worker safety in the COVID-19 era (PPE-SAFE): an international survey. Journal of critical care. 2020;59:70-75.
Hu K, Fan J, Li X, Gou X, Li X, Zhou X. The adverse skin reactions of health care workers using personal protective equipment for COVID-19. Medicine. 2020;99(24).
Tirupathi R, Bharathidasan K, Palabindala V, Salim SA, Al-Tawfiq JA. Comprehensive review of mask utility and challenges during the COVID-19 pandemic. Infez Med. 2020;28(suppl 1):57-63.
Abd-Elsayed A, Karri J. Utility of substandard face mask options for health care workers during the COVID-19 pandemic. Anesthesia and analgesia. 2020.
Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ. Rational use of face masks in the COVID-19 pandemic, Lancet Respiratory Medicine. 2020;8(5), 434-436.
van der Westhuizen HM, Kotze K, Tonkin-Crine S, Gobat N, Greenhalgh T. Face coverings for covid-19: from medical intervention to social practice. bmj. 2020;370.
Long Y, Hu T, Liu L, Chen R, Guo Q, Yang L, Cheng Y, Huang J, Du L. Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta"analysis. Journal of Evidence"Based Medicine. 2020;13(2):93-101.
Barycka K, Szarpak L, Filipiak KJ, Jaguszewski M, Smereka J, Ladny JR, Turan O. Comparative effectiveness of N95 respirators and surgical/face masks in preventing airborne infections in the era of SARS-CoV2 pandemic: A meta-analysis of randomized trials. PLoS One. 2020;15(12):e0242901.
Radonovich LJ, Simberkoff MS, Bessesen MT, Brown AC, Cummings DA, Gaydos CA, Los JG, Krosche AE, Gibert CL, Gorse GJ, Nyquist AC. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial. Jama. 2019;322(9):824-833.
Smith JD, MacDougall CC, Johnstone J, Copes RA, Schwartz B, Garber GE. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. Cmaj. 2016;188(8):567-74.
Vickers NJ. Animal communication: when i'm calling you, will you answer too?. Current biology. 2017;27(14):R713-5.
O'Kelly E, Arora A, Pirog S, Ward J, Clarkson PJ. Comparing the fit of N95, KN95, surgical, and cloth face masks and assessing the accuracy of fit checking. PloS one. 2021;16(1):e0245688.
Clinkard D, Mashari A, Karkouti K, Fedorko L. Evaluation of N95 respirators, modified snorkel masks and low"cost powered air"purifying respirators: a prospective observational cohort study in healthcare workers. Anaesthesia. 2021;76(5):617-622.
Pacis M, Azor-Ocampo A, Burnett E, Tanasapphaisal C, Coleman B. Prophylactic dressings for maintaining skin integrity of healthcare workers when using N95 respirators while preventing contamination due to the novel coronavirus: a quality improvement project. Journal of Wound, Ostomy, and Continence Nursing. 2020;47(6):551.
Guschel S, Chmiel K, Rosenstein J. Use of Thin Dressings Under N95 Respirators: Exploring Their Effect on Quantitative Fit Testing Results to Guide Hospital Practice During the COVID-19 Pandemic. Wound Management & Prevention. 2020;66(11):13-17.
Smart H, Opinion FB, Darwich I, Elnawasany MA, Kodange C. Preventing facial pressure injury for health care providers adhering to COVID-19 personal protective equipment requirements. Advances in skin & wound care. 2020.
Cabbarzade C. A practical way to prevent nose and cheek damage due to the use of N95 masks in the COVID-19 pandemic. Aesthetic Surgery Journal. 2020;40(10):NP608-10.
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