Rash, Sweat, Bruises: Wearing PPE for Hours Causing Skin Infection

FIT spoke to doctors to understand their struggles in wearing the heavy & layered equipment for hours on a stretch.

Updated07 May 2020, 08:38 AM IST
Coronavirus
5 min read

"Soaked skin combined with pressure increased friction coefficient between the PPE and skin, and when masks and goggles were removed quickly, skin tear was ready to happen," says a study, indicating what doctors go through everyday while wearing PPEs for hours on duty.

In our battle against COVID-19, the availability of good quality Personal Protective Equipment (PPE) has become a major area of concern - and for good reason. Doctors, nurses and healthcare professionals working in clinics and hospitals heavily depend on the safety gear to minimise the risk of getting infected themselves while they treat patients.

But ensuring the availability of the equipment is only the first hurdle. Wearing the PPEs and spending hours after hours in layers of masks, gloves, hooded caps, face shields, goggles, gowns, shoe covers and towels - all that the kit comprises of - can be exhausting, tiresome and extremely uncomfortable.

Many doctors have taken to social media to share pictures of themselves after removing the PPEs, with marks, acne, redness and even bruises all over their faces.

Rash, Sweat, Bruises: Wearing PPE for Hours Causing Skin Infection
(Photo: Twitter/iOWNA wHealth)
Rash, Sweat, Bruises: Wearing PPE for Hours Causing Skin Infection
(Photo: Instagram/oritmarkowitzmd)
Rash, Sweat, Bruises: Wearing PPE for Hours Causing Skin Infection
(Photo: Instagram/oritmarkowitzmd)
Rash, Sweat, Bruises: Wearing PPE for Hours Causing Skin Infection
(Photo: Twitter/Theresa Madaline)

FIT spoke to healthcare professionals to understand their difficulties and struggles in wearing the heavy and layered equipment for hours on a stretch. Excessive sweating, irritation and rashes have been a common experience for many, we found.

PPEs and Skin Problems

A recent study covering 161 COVID-19 hospitals and 4,308 health care respondents in China found that over 40 percent of the individuals suffered from some or the other kind of skin injury after wearing PPEs for around 7.7 hours. A third of them also experienced heavy sweating, which may have further led to irritation, rashes, redness and itching.

The three most common forms of injury were: device-related pressure injuries, moisture-associated skin damage, and skin tears over various parts of the body. Nose bridge, cheeks, ears, and forehead were the most impacted areas.

These concerns are widely known and acknowledged around the world. NHS England has published a list of guidelines titled ‘Helping Prevent Facial Skin Damage Beneath Personal Protective Equipment ’, which includes tips such as keeping the skin clean and hydrated before wearing the mask, fitting the mask and placing it properly, and ensuring that both the skin and the mask are clean and thoroughly dry before getting into the gear.

But the challenges and difficulties of donning the equipment and staying in it for hours continue to affect doctors and workers.

In conversation with FIT, Dr Udgeath Dhir, Director & Head, Cardiothoracic and Vascular Surgery at Fortis, Gurugram, shared, “Most of the PPE kits we are using are non-porous. They have to be made airtight so that the virus doesn’t pass through. On top of this is our N95 mask, all of which together makes it very difficult to breathe.”

“There’s accumulated sweat, causing irritation and itching. But we can’t itch or touch our rashes. Marks remain on our foreheads for a minimum of 10 hours after removing the kits; and similar ones are there on most of our bony prominences.”
Dr Udgeath Dhir

“The gloves that we are using in the ICU, which are actually the ideal kind to be used right now (because they don’t allow viruses and microorganisms to come in), can also lead to compression in our hands, affect circulation, and cause allergic reactions.”

Dr Udgeath Dhir in his PPE.
Dr Udgeath Dhir in his PPE.
(Photo Courtesy: Dr Udgeath Dhir)

He adds that because they are wearing closed air masks, the carbondioxide levels are higher, which leads to a bit of headache once removed.

“The kind of extra physical labour comes to the tune of more than 50% than what we were doing previously without these PPE kits. Even though we have good quality equipment, working in it is very tough.”
Dr Udgeath Dhir

Researchers who conducted the aforementioned study offered several explanations for the discomfort caused by the PPEs, the most prominent one being the long working hours, far extending the ideal PPE-replacement time of every four hours.

“Of their long hours wearing PPE, the N-95 respirators or surgical masks and goggles would compress nose-bridge and cheeks, a mask strap would compress the ears, and face shield and surgical cap would compress the forehead, which might be the main cause of skin injuries on multiple parts of the head and face,” the study said.

Dr Lok Raj Sharma, who operates his own clinic in Delhi, shares,

“You sweat a lot in a double-cover PPE. The N95 masks, face shields and the goggles cover all of your head and ears, making you feel slightly claustrophobic into an hour of wearing them. Throughout this time, you can’t go to the loo or eat or drink anything. Some doctors are even wearing adult diapers now for this purpose.”
Dr Lok Raj Sharma

The major issue, Dr Sharma adds, is the sweating.

The study also stated, “Soaked skin combined with pressure increased friction coefficient between the PPE and skin, and when masks and goggles were removed quickly, skin tear was ready to happen.”

Dr Sumit Ray, a critical care specialist also spoke about his experience wearing the equipment. “The PPE doesn’t let you breathe too well and retains your sweat, so it can cause allergies and fungal infections, especially because you are in a hot and humid environment. I haven’t suffered any allergies personally, but the irritation and discomfort is very much there,” he told FIT.

But there is no other option, concede doctors. PPEs are critical in protecting the frontline workers, despite the discomfort they cause. The need to make the kits available in enough quantity for doctors to be able to change them every few hours will help mitigate the issues they face. Maintaining the quality of the equipment is of utmost importance, as any breach could lead to them catching the infection.

“Yes, it’s uncomfortable. It’s a tough way, but it is the only way,” Dr Dhir says.

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Published: 07 May 2020, 03:14 AM IST
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