COVID update

Facial pressure injuries and the COVID‑19

pandemic: skin protection care to enhance
staff safety in an acute hospital setting

Objectives: The aim of this study was to determine the impact of a respondents reported developing a facial PI, whereas after using the
specially designed care bundle on the development of facial pressure care bundle only 8% (n=9) of the respondents reported developing a
injuries (PI) among frontline healthcare workers wearing personal facial PI. The odds ratio (OR) of skin injury development was 4.75
protective equipment (PPE) during the COVID-19 pandemic. The (95% confidence interval (CI): 2.15–10.49; p=0.0001), suggesting
primary outcome of interest was the incidence of facial PIs. The that after the care bundle was issued, those who responded to the
secondary outcomes of interest were facial pain while wearing PPE survey were almost five times less likely to develop a skin injury.
and ease of use of the care bundle. Interviews with 14 staff determined that the bundle was easy to use
Methods: This study used a voluntary survey by questionnaire, and safe.
supplemented by a qualitative analysis of interviews from a small Conclusion: Among those who responded to the survey, the use of
purposive sample that took place in one large Irish hospital over a the bundle was associated with a reduction in the incidence of skin
two-month period in 2020. The hospital was a city-based public injury from 29% to 8%, and respondents found the bundle easy to
university teaching hospital with 800 inpatient beds. The intervention use, safe and effective. As with evidence from the international
was a care bundle consisting of skin protection, face mask selection, literature, this study has identified that when skincare is prioritised,
material use, skin inspection, cleansing and hydration developed in and a systematic preventative care bundle approach is adopted,
line with international best practice guidelines. All staff working in there are clear benefits for the individuals involved.
COVID-19 wards, intensive care units and the emergency department Declaration of interest: Eucerin Aquaphor Soothing Skin Balm
in the hospital were given a kitbag containing the elements of the (Beiersdorf, Hamburg, Germany) and WaterWipes baby wipes
care bundle plus an information pamphlet. Data were collected via a (WaterWipes UC, Drogheda, Ireland) were both donated. Fleming
survey and interviews. Medical (County Limerick, Ireland) distributed Mepitac tape
Results: A total of 114 staff provided feedback on the use of the (Mölnlycke Health Care AB, Gothenburg, Sweden) at a reduced cost.
care bundle. Before using the care bundle 29% (n=33) of the The authors have no conflicts of interest to declare.

COVID-19  ●  facial pressure injury  ●  personal protective equipment  ● PPE ●  staff safety  ● wound ●  wound healing

A
s of 11 February 2021, there had been Ireland with COVID-19, and over 1200 people had
more than 200,000 confirmed cases of been admitted to intensive care units (ICU).1 While
COVID-19 and over 3800 COVID-19- the overall percentage of COVID-19-positive cases
related deaths in Ireland. 1 Over requiring ICU care is low (<1%), within older age
12,000  people had been hospitalised in groups ICU admission rates are as high as 25%.1 This
has meant a significant increase in workload for
healthcare staff in providing daily frontline care to
Zena Moore,1,2,3,4,5 PhD, MSc (Leadership in Health Professionals Education), patients with COVID‑19. The care delivery model
MSc (Wound Healing & Tissue Repair), FFNMRCSI, PG Dip, Dip First Line Management,
RGN, Professor, Chair of Nursing, SWaT Director; Natalie L McEvoy,1,6 MSc, PGDip,
necessitates the wearing of personal protective
BSc, RGN, Research Nurse; Pinar Avsar,1 PhD, MSc, BSc, RGN, Senior Post Doctoral equipment (PPE). For COVID‐19, recommendations
Researcher*; Linda McEvoy,6 MSc, BSc, HDip (Neurosciences), RCPI Dip, RGN, Clinical for PPE are gloves, masks, goggles or face shields, and
Audit and Governance Manager; Gerard Curley,6,7 Professor of Anaesthesia and Critical long‐sleeved gowns. 2,3 Face masks used among
Care, and Consultant in Anaesthesia and Intensive Care; Tom O’Connor,1,2,5 EdD, MSc
healthcare providers depend on the setting, personnel
Ad Nursing, PG Dip Ed, BSc, Dip Nur, RNT, RGN, Professor; Aglecia Budri,1 PhD, BSc,
RGN, Lecturer; Linda Nugent,1,2 PhD, MSc Advancing Nursing Practice, FFNMRCSI, and level of activity.2 Masks include medical masks,
PG Dip Ed, BSc, RGN, Lecturer; Simone Walsh,1 PMP, MSc Public Health, BSc Nursing respirator N95 or FFP2 standard, or equivalent.2
Management, PG Cert Medical Toxicology, RGN, Senior Research Projects Manager; Until now, device-related pressure injury (PI)
Frank Bourke,1 Learning Technologist; Declan Patton,1,2,8 PhD, MSc, PGDipEd, prevention strategies have been directed towards
PGCRM, BNS(Hons), RNT, RPN, Professor
*Corresponding author email: [email protected]
patients.4 However, anecdotal information, nationally
1  School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, RCSI and internationally, suggests that facial pressure injuries
© 2021 MA Healthcare ltd

University of Medicine and Health Sciences, Dublin. 2  Fakeeh College of Health Sciences, (FPIs) are a significant problem resulting from wearing
Jeddah, Saudi Arabia. 3  Faculty of Medicine, Nursing and Health Sciences, Monash protective face masks,4,5 which, without a skin protector,
University, Australia. 4  Department of Public Health, Faculty of Medicine and Health
mechanically indent the skin.6 The most common sites
Sciences, Ghent University, Belgium. 5  Lida Institute, Shanghai, China. 6  Beaumont
Hospital, Dublin. 7  School of Medicine, RCSI University of Medicine and Health Sciences, where FPIs occur have been reported as the bridge of the
Dublin. 8  Faculty of Science, Medicine and Health, University of Wollongong, Australia. nose, cheeks, ears and forehead.5 One study reported

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 COVID update

the overall prevalence of skin injuries caused by PPE in the emergency department in the hospital were given a
medical staff as 42.8% (95% confidence interval (CI): kitbag containing the elements of the care bundle plus
41.30–44.30%).5 This information is consistent with an information pamphlet. All of these staff were then
published data subsequent to the SARS epidemic.7 invited to participate in the study, by voluntarily
Furthermore, hospital personnel who are not directly completing the study questionnaire. Further to the
involved in patient care must now also wear PPE, survey, purposive sampling was used to select
meaning that the numbers of professionals and service 14  interview participants who used the bundle. The
providers wearing PPE has significantly increased.4 14 staff who were selected all had to be working in one
During the current COVID-19 pandemic, evidence of the COVID-19 clinical areas, wearing PPE and using
through social media channels and anecdotally from the care bundle. This was essential in order for them to
those wearing protective masks in healthcare settings answer the questions asked.
has emerged of FPIs caused by the prolonged wearing of
face masks. Intervention
FPIs develop when the skin is indented with the The care bundle was developed in line with international
continuous use of face masks.8 By definition, PIs are a best practice.6,9,13,14 The bundle consisted of five steps
localised injury to skin or underlying tissue, usually using WaterWipes baby wipes (WaterWipes UC,
over a bony prominence, because of prolonged pressure Drogheda, Ireland), Eucerin Aquaphor Soothing Skin
or shear.9 FPIs can have a devastating effect on staff Balm (Beiersdorf, Hamburg, Germany) and Mepitac
who are already overworked and anxious, and place tape (Mölnlycke Health Care AB, Gothenburg, Sweden).
them at an increased risk of developing an infection, All staff were provided with WaterWipes baby wipes
including COVID-19 itself.10–12 Additionally, single-use to ensure that the facial area was cleansed. The wipes
face masks were not originally designed to be worn are made with only two ingredients (99.9% water and
continuously for several hours; therefore, the prolonged fruit extract). Research on WaterWipes used with babies
use of PPE as seen during the COVID-19 pandemic has shown that mothers reported a lower incidence of
further contributes to the incidence of FPIs among nappy rash.15 It had not been studied in an FPI context
health professionals.4 before, but was readily available for use during what was
To address this clear and present problem, the a national emergency in Ireland. The manufacturer was
research team developed an evidence-based care bundle also responsive to the research team’s call for assistance
for use by COVID-19 frontline staff, targeting the in developing the care bundle during what was a
prevention of FPIs, with a resultant evaluation of its national emergency at the peak of the first wave of
impact on the acquisition of FPIs, pain and ease of use COVID-19.
of the bundle. Staff then applied Eucerin Aquaphor Soothing Skin
Balm once the skin was cleansed and dry. Over-the-
Methods counter skin protectants may be an effective, widely
Research question available and inexpensive means of reducing the
What is the impact of a care bundle on the development frictional forces applied by PPE on facial skin.4 Given
of FPI among frontline healthcare workers? that the balm was a readily available, over-the-counter
product, it was chosen for use in the care bundle.
Design Similarly to the wipes, the manufacturer was quickly
The design used adopted a voluntary survey by responsive to helping the research team develop the
questionnaire, supplemented by a qualitative analysis care bundle.
of interviews from a small purposive sample. Staff then cut Mepitac tape to size and applied it
directly to the bridge of the nose and cheekbones. The
Outcomes purpose of the tape was to serve as a barrier against the
The primary outcome of interest was the incidence of frictional forces endured by those wearing PPE. The tape
FPIs. Secondary outcomes of interest were facial pain is easy to tear, is breathable and can be applied to
while wearing PPE and ease of use of the care bundle. different areas of the face. Personal experience of using
the tape among some members of the research team was
Site the main reason for the selection of this tape. This was
This study took place in one large Dublin based, public a pragmatic choice and the tape was readily available to
university teaching hospital, with 800 beds, over the the research team.
two-month period March–May 2020. Thus, the five steps to using the bundle are as
follows:
Access 1. Skin protection, using cleansing and moisturisation
© 2021 MA Healthcare ltd

Permission to access the staff was provided by the 2. Selection of a face mask appropriate to the level of
hospital research audit committee (Ref: CA946). care to be provided
3. Material use, application of tape and face mask
Population and sample 4. Skin and face mask inspection during the clinical
All staff (n=300) working in COVID-19 wards, ICU and shift as appropriate

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 COVID update

5. Skin inspection, cleansing and hydration on removal Data analysis

of the PPE and tape. Survey data were entered onto SPSS version 25 (IBM
The care bundle was available on a smartphone app Corp., US), and analysed using descriptive statistics.
which could be downloaded by all participants, and on a Inferential statistical analysis was undertaken using
poster, many of which were displayed in the PPE donning RevMan Version 5.3. (Cochrane Training), with a forest
and doffing area and the staff room within the selected plot generated displaying the odds ratio (OR) and 95%
clinical areas. The development of the care bundle and CI. Thematic analysis16 was used to reduce and
the supply of the kits were made possible through a staff categorise qualitative data gathered during the
fundraising initiative and support from industry. The semi‑structured interviews.
fundraising element was coordinated by the Development
Office at the Royal College of Surgeons in Ireland (RCSI) Results
University of Medicine and Health Sciences. Survey
Demographics
Data collection A total of 114 staff provided feedback on the use of the
Data were collected between March and May 2020. care bundle. As would be expected, nursing staff
After three consecutive shifts using the care bundle, accounted for the largest group (68%; n=78). However, a
each participant was invited to voluntarily complete range of staff used the care bundle, as shown in Table 1.
the cross-sectional survey, anonymously on their
smartphone. The survey questions elicited Skin injury before use of the care bundle
information pertaining to the individuals’ discipline, In total, 29% (n=33) of the respondents reported that
the incidence of skin injury before and during the use they had a skin injury before using the care bundle.
of the bundle, the nature of the skin injury, pain, Table 2 outlines the type of skin injury experienced, and
comfort and ease of use of the care bundle. The online as can be seen, an abrasion was the most common
survey was hosted on a WordPress website and was (16%; n=18), followed by a skin tear (9%; n=10).
built by an educational technologist using the Smart
forms plugin. Survey data were collected in real time Skin injury during use of the care bundle
on an Excel spreadsheet (Microsoft Corp., US). To assist In total, 8% (n=9) of the respondents reported that they
with the ease of data analysis, the spreadsheet used a had a skin injury while using the care bundle. Table 3
basic tabulation framework to make sense of data. This outlines the type of skin injury experienced, and as can
helped to tabulate data into easily understandable be seen, a skin tear (3.5%; n=4) was the most common.
rows and columns, and this assisted in drawing The mean number of days to skin injury development
parallels between different research parameters. was 2.33 (SD: 0.71; median: 2; range: 1–3).
Qualitative data were also collected via a small
number of one-to-one semi-structured interviews from Table 1. The professional discipline of the staff
using the care bundle
selected staff. These participants were asked to
elaborate further on safety and their overall perceptions Discipline Frequency Percent
of the care bundle. Set interview questions were as
Nurse 78 68
follows, and interspersed within these were
further probing questions that arose from interview Doctor 6 5
to interview:
Physiotherapist 10 9
1. Staff satisfaction: Can you talk to me about your
experience of the care bundle? Healthcare assistant 9 8
2. Can you talk to me about anything else that would
Other 11 10
have benefitted you in terms of the care bundle?
3. Protection: Can you talk to me about your experience Total 114 100
of how the protective tape interacted with the
functioning of the mask? Table 2. Type of skin injury, pre-use of the care
4. Recommendations for practice: Would you bundle
recommend this care bundle to a colleague?
Type of skin injury Frequency Percent
5. Is there anything else you would like to discuss
around the care bundle and your experiences? Abrasion 18 16
Each interview was completed by the same person.
Blister 1 1
Interviews were written from speech to text once
someone completed their third consecutive shift in Deep sore 4 4
© 2021 MA Healthcare ltd

their particular clinical setting. Participants signed

Skin tear 10 9
that the written record was an accurate reflection of
what they said. A further member of the None 81 70
team performed the thematic analysis and no
Total 114 100
disagreements occurred.

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 COVID update

Fig 1. Forest plot: odds ratio of skin injury development, care bundle versus usual care
Study or Pre-care bundle Post-care bundle Weight Odds ratio Odds ratio
subgroup
Events Total Events Total M–H, fixed [95% Cl] M–H, fixed (95% Cl)

Study group 2020 33 114 9 114 100.0% 4.75 [2.15, 10.49]

Total 114 114 100.0% 4.75 [2.15, 10.49]

Heterogeneity: not applicable

0.01 0.1 0 10 100
Test for overall effect: Z=3.86 (p<0.0001)
Favours [usual care] Favours [care bundle]
M–H—Mantel–Haenszel; CI—confidence interval

Odds ratio of skin injury development, PPE was removed. As can be seen in Table 5, the mean
care bundle versus usual care pain score was 1.73 (SD: 2.11; median: 1; range: 0–9).
Fig 1 outlines the forest plot of the odds ratio of skin
injury development. In the pre-care bundle group 29% How easy was the care bundle to use?
(n=33) of the respondents reported that they developed Staff rated, on a scale of 0–10, how easy they found the
a skin injury, whereas in the post-care bundle group care bundle to use. As can be seen in Table 6, the mean
8% (n=9) of the respondents reported that they score was 7.76 (SD: 3.06; median: 9; range: 0–9).
developed a skin injury. The OR of skin injury
development is 4.75 (95% CI: 2.15–10.49; p=0.0001), Would you recommend this care bundle to a colleague?
meaning that after the care bundle was issued, Staff rated, on a scale of 0–10, how likely they would be
respondents were almost five times less likely to to recommend the care bundle to a colleague. As can be
develop a skin injury. seen in Table 7, the mean score was 8.25 (SD: 2.61;
median: 10; range: 0–10).
Pain while wearing PPE with the care bundle
Staff rated their pain on a scale of 0–10 while using PPE Interviews
with the care bundle. As can be seen in Table 4, the mean One-to-one semi-structured interviews (n=14) were
pain score was 3.18 (SD: 2.44; median: 3; range: 0–10). completed, where participants were asked to elaborate
further on safety and their overall perceptions of the
Pain once the PPE was removed care bundle. The majority of respondents were nurses
Staff also rated their pain, on a scale of 0–10, once the (64.2%; n=9) (Table 8).
Following thematic analysis using the approach
Table 3. Type of skin injury while using the care designed by Attride-Sterling,16 three themes emerged
bundle from the data:
Type of skin injury Frequency Percent 1. The care bundle maintained my safety
2. The care bundle and its effect on my mask
Abrasion 2 2
3. Ease of use of the care bundle.
Blister 2 2
Theme 1: The care bundle maintained my safety
Deep sore 1 1 Each of the 14 respondents (N1 to N14) commented
Skin tear 4 3 on how the care bundle prevented further FPIs. The
particular FPIs mentioned were pressure sores,
None 105 92 blisters and redness. The following participants
Total 114 100 summed up the sentiments expressed by all
interview participants.

Table 4. Pain while wearing personal protective

It was so good I didn’t have any marks coming out but I
equipment (PPE) with the care bundle
usually mark so easily. I felt like it really helped alleviate
Scale: 0=no pain, 10=worst pain imaginable the pressure as well. (N2)
Mean 3.18
It definitely prevented a pressure sore on my nose. I had
Median 3 what looked like an abrasion when this all started
© 2021 MA Healthcare ltd

(Covid). Now I don’t even get redness. (N6)

Standard deviation 2.44

Minimum 0 It is clear from the quotes that participants felt that

using the care bundle in its entirety helped prevent a
Maximum 10
new FPI.

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 COVID update

Theme 2: The care bundle and its effect on my mask Table 5. Pain once the PPE was removed
One of the issues that the research team was wary of
Scale: 0=no pain, 10=worst pain imaginable
prior to the use of the care bundle was that it may affect
the efficacy of the face mask seal. Each participant Mean 1.73
expressed that the elements of the care bundle did not Median 1.00
compromise the protective nature of the face mask. The
quotes from the following participants represent those Standard deviation 2.11
of the whole group.
Minimum 0

No not at all, the dressings we were using before the Maximum 9

bundle affected the seal but the tape as part of the
bundle didn’t. It definitely helped a lot. (N2)
Table 6. Ease of use of the care bundle
No it didn’t interfere with the seal on my mask like some Scale: 0=difficult, 10=easy
other dressings did. (N5)
Mean 7.76

Mask functioned well. I didn’t notice a difference in the Median 9

seal. (N9)
Standard deviation 3.06
Initial concerns held by the research team were not Minimum 0
realised because the care bundle elements did not
reduce or interfere with the efficacy of the face mask as Maximum 10
an item of PPE. The education contained in the
smartphone touch-app given to every participant Table 7. Recommendations for using the care bundle
assisted in this.
Would you recommend this care bundle to a colleague?
(0=least likely, 10=very likely)
Theme 3: Ease of use of the care bundle
The research team deemed it important to ascertain if Mean 8.25
the care bundle was easy to use. This was important
Median 10
considering the intense nature of providing COVID-19
care and treatment. Participants talked about the ease Standard deviation 2.61
with which they used the care bundle, forming the view
that it was not a chore to use it. The comments made Minimum 0

by these two participants were a representation of what Maximum 10

every participant expressed.

The poster was easy to follow. (N7)

Table 8. The professional discipline of interview
respondents
The poster was easy to follow and I found the bundle
easy to use. (N1) Interview participants

Doctor 2
An easy-to-use care bundle ensured that participants
used the bundle every day before fitting their face mask Healthcare assistant 2
and at the end of the shift.
Nurse 9

Discussion Physiotherapist 1
The COVID-19 outbreak is challenging for all healthcare
Total 14
professionals on a collective and individual level.17 The
need for this study was borne out of the fact that the
safety of frontline staff was of paramount importance safe PPE for frontline staff is vital in order to ensure the
during the COVID-19 emergency. A clear and present health and wellbeing of staff and to ensure safe staffing
threat to staff safety was the emergence of FPIs because of COVID-19 care areas.21
of the prolonged wearing of protective face masks and This study involved the development of an easy-to-
goggles. Skin tears or friction lesions as a result of use, evidence-based, five-step care bundle for use by
© 2021 MA Healthcare ltd

intensive and prolonged use of PPE have been reported COVID-19 staff. The key elements of the bundle included
and photographed extensively in the general media face wipes, moisturiser and protective tape, with each
worldwide since the COVID-19 outbreak began. FPIs element acting in synergy. Thus, the bundle emerged as
have also been recently reported in dermatology an all-in-one protector for staff against FPIs. This is of
literature.18–20 The importance of training and providing particular importance, given the negative impact that

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 COVID update

FPIs have in terms of the risk of pain, discomfort and that the bundle reduced pain. Interview data augmented
infection, including that of COVID-19 itself.10–12 The this with participants paying particular attention to the
systematic education touch-app available on the ease of use of the bundle, specifically how it did not
smartphones of participants ensured ready access and interfere with the protective mask, and how it was not a
ease of use. Nonetheless, only 38% of those who received burden for them to use. The interaction between the
the care bundle responded to the survey. It was presumed chosen protective tape and mask functioning was of
that everyone installed the touch-app, but this may not importance in the present study. Whether applying
have been the case. Indeed, some participants may have prophylactic dressings onto sensitive facial sites may
used the bundle but not installed the app. Another compromise the seal of a medical face mask is an ongoing
possible reason for the response rate was that all staff debate among clinicians and researchers alike. In the
were working in COVID-19 facing areas during the worst present study, interview data clearly demonstrated that
of the pandemic and may simply not have had the time, the protective tape did not affect the seal or functioning
energy or inclination to respond to the survey. of face masks as reported by healthcare providers.
In this study, the research team determined the
incidence of FPIs among staff who responded to the Limitations
survey, working in COVID-19 clinical areas within an More critically, some elements of bias could have affected
800-bed, public university teaching hospital in Dublin, the study. For example, the staff who took part in the
Ireland. The use of the bundle was associated with a study did so voluntarily by receiving and using the care
reduction in the incidence of skin injury from 29% to 8% bundle pack, and thus staff were not randomly selected.
among those who responded. It is important to highlight However, not everyone responded to the survey. Had the
the incidence of this problem among staff as the growing nonresponders completed the survey then findings may
use of FPIs in COVID-19 care areas has been extensively have been different. Also, the responses of those who
reported across social media platforms. However, this completed the survey were based solely on self-response
incidence figure is below the 42% reported by Jiang et al.5 with no validation of injury, such as photographs of
The reason for this difference may be that the study by injury or whether those who sustained an FPI were
Jiang et al.5 was reported as the first cross-sectional survey already susceptible to skin injury or used additional
completed by COVID-19-facing medical staff early in the skincare strategies. Additionally, the improvement in
pandemic. By the time the current study took place, the skin condition attributed by the authors to the care
application and wearability of PPE may have been better. bundle may have been due to other factors, such as
Furthermore, the study by Jiang et al.5 took place across differing lengths of time wearing PPE or the particular
161 hospitals in China, whereas the present study took ward setting in which participants worked, a factor
place in one Irish hospital, and as such may reflect a which may have affected the mean length of skin damage
different context to data collection. Additionally, in a of 2.33 days. Wear time is a factor that should be
recently published practical tip sheet on maintaining addressed in future studies as it may differ from person
skin health and integrity for staff wearing PPE for to person or ward to ward. Changes in staff wellbeing, or
prolonged periods of time, a recommendation for future the fact that they were part of the study and received
research in this area was to determine the incidence of training, is something that could also have been explored
FPIs among healthcare workers wearing PPE in order to in greater detail. These are all important factors that
evaluate the maintenance of integrity of mask function require exploration in future studies on the bundle, in
when a prophylactic dressing is applied.22 In the present order to enhance the validity of what was found in this
study, the impact of a specially designed care bundle on study and to reduce possible bias. Allied to this point is
the development of FPIs among frontline healthcare that while the care bundle consisted of five steps to be
workers wearing PPE has been examined, partially completed sequentially, it is not clear what the critical
addressing this gap in the literature. However, previously step, or steps, were; again, this needs to be validated in
employed skin protection methods used by participants future studies, perhaps leading to a more refined process
and how this may have affected the outcomes was of application, wear and removal of the bundle elements.
not addressed. Despite this, it has been highlighted that when using
Crucially, this study sought to ascertain if the care care bundles in clinical practice, it is the consistent
bundle reduced the chances of staff acquiring an FPI and application of all the elements of the bundle that yields
if the care bundle enhanced comfort. It is important to success.23 Thus, we have followed this guidance, and as
emphasise the association between pain and discomfort such the purpose was not to explore the impact of one
with infection control measures. A study carried out in element of the bundle over another, rather it was to
Italy reported that even mild facial skin abrasions, explore the effect of the bundle as a whole.
itching or burning sensation, instinctively resulted in
© 2021 MA Healthcare ltd

users touching masks, respirators or goggles in order to Conclusion

adjust their position to reduce the level of discomfort or This study has demonstrated that it is possible to
pain.20 In the current study, survey data demonstrate reduce the incidence of FPIs and reduce pain. However,
that using the care bundle made it less likely that staff more needs to be done to ensure the prevention of FPIs
would develop an FPI, while survey data also showed and associated pain from prolonged wearing of PPE.

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 COVID update

Clinical colleagues are working in circumstances that COVID‑19 pandemic, it has become apparent that staff
are challenging and research suggests that frontline have experienced FPIs from the prolonged use of PPE.
staff are experiencing anxiety, depression and insomnia In response to this, the research team quickly developed
during the COVID-19 outbreak.24 It is of the utmost an easy to use five-step care bundle. In the sample
importance that researchers stand in solidarity with responding to the survey, the use of the care bundle was
clinical colleagues on the frontline, providing evidence- associated with a reduction in the incidence of facial
based solutions to problems they are encountering pressure injury from 29% to 8%, and the bundle was
during these unprecedented times. This study has reported as being easy to use, safe and effective.
provided an intervention that can help prevent the Consistent with evidence from the international
emergence of FPIs that compromise staff safety when literature, when skincare is prioritised, and a systematic
they are providing care to COVID-19 patients in acute preventative care bundle approach is adopted, there are
care settings. However, it does require further clear benefits for the individuals involved. Furthermore,
investigation to ensure that the products used directly reaching out to frontline staff to provide support has
affected the outcomes. the added benefit of enhancing wellbeing. This has
Protection of frontline healthcare workers is a priority, never been more important than during the current
to ensure that staff may work without harm from the pandemic, where clinical colleagues are facing
use of equipment that is meant to be, in the first unprecedented safety challenges in their day-to-day
instance, protective in nature. Throughout the work.  JWC

Acknowledgements
The study was supported by a fundraising campaign led by RCSI, 15 Price AD, Lythgoe J, Ackers-Johnson J et al. The BaSICS (Baby Skin
University of Medicine and Health Sciences, Dublin. Integrity Comparison Survey) study: a prospective experimental study
using maternal observations to report the effect of baby wipes on the
References incidence of irritant diaper dermatitis in infants, from birth to eight weeks
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Ireland: daily infographic. 2021. https://tinyurl.com/140zh11v (acessed 15 perneo.2020.10.003
February 2021) 16 Attride-Stirling J. Thematic networks: an analytical tool for qualitative
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