NY Hospital Workers' Skin Took Substantial Toll in Pandemic

NEW ORLEANS -- Most workers at a major New York City-area hospital said they suffered significant skin reactions from the personal protective equipment (PPE) they were required to wear as the COVID-19 pandemic took hold, according to a survey reported here.

Among 148 workers who responded, ranging from respiratory therapists to physicians, 105 indicated that they had experienced rashes, eruptions, and/or pressure sores that they attributed to PPE, said David Frankel, MD, of the New York University (NYU) Long Island campus in Mineola, New York.

The worst offender: N95 respirators. More than 85% of respondents identified them as causing skin reactions, Frankel reported at a poster presentation at the American College of Allergy, Asthma, and Immunology annual meeting.

Across all categories of equipment, which also included gloves, gowns, goggles, face shields, and surgical masks, redness was the most common problem reported. But each type of PPE worn directly against the skin was also responsible for a substantial numbers of complaints about eczema and hives.

Perhaps most worrisome, 26% of all respondents said they had to quit wearing PPE except when performing direct patient care because of the skin problems.

Frankel noted that few studies of skin reactions related to PPE have been conducted in the U.S. during the COVID-19 epoch. Nearly all the existing literature either predated the pandemic (for example, following the previous decade's SARS outbreak) or came from China's early experience with COVID.

The NYU study may have been underpowered to examine some questions, such as whether duration of PPE use or history of atopy or contact dermatitis were related to the incidence of skin effects. One would expect so, but Frankel said there was no significant association with either of these, as reported by survey participants. He told MedPage Today, however, that the worker categories with the highest incidence of PPE-related skin problems -- nurses and respiratory therapists -- were also those whose use of PPE increased the most as the pandemic unfolded.

While N95s prompted the most complaints, surgical masks were not far behind, with 60% of workers saying they caused skin problems. In third place were gloves (about 32%), followed by face shields (30%).

Acneiform eruptions were a particular problem for N95s and surgical masks, each reported by more than 40% of respondents. Frankel noted that women and workers younger than age 30 appeared most susceptible to this issue.

Least problematic were gowns and goggles, neither of which drew complaints from even 5% of respondents.

The survey didn't get directly at how the PPE caused the skin problems, but Frankel theorized that allergic reactions were probably less important than the physical rubbing of synthetic materials against the skin -- contact dermatitis. At the same time, though, he said that polypropylene is often used in medical masks and it is a known allergen.

As for what hospitals and workers can do to minimize the risk -- given that PPE in patient care is a fact of life for the indefinite future -- he said emollients on the hands can make gloves more tolerable, and use of tissue paper and Vaseline on the face can do likewise for respirators and masks.

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