Authors (including presenting author) :
Chong HM(1), Pun MK(1), Wan YP(2), Chung CM(2)
Affiliation :
(1)Nursing Service Division, Tuen Mun Hospital, (2)Department of Surgery, Tuen Mun Hospital
Introduction :
The COVID-19 pandemic has changed daily practices in healthcare settings and rise of numbers of Medical Device related Pressure Injury (MDRPI) caused by personal protective equipment. Patients are required to put on surgical masks in clinical areas and inevitably increase their risks of getting facial injury especially in auricular areas. The skin complications and mask discomfort may disrupt their compliance of mask wearing. Therefore, various wound dressing materials had been applied as prophylaxis in order to reduce the incidence of the injury. However, no study has integrated the efficacies of those prophylactic dressings.
Objectives :
The aim of this study is to compare the efficacies of three preventive measures: application of silicone tape, hydrocolloid sheet and modification of surgical mask ear loop with adhesive dressing tape. The outcome measures are based on skin integrity, improvement of pain level and comfort level.
Methodology :
The study was conducted in a mixed-gender, 24-bed general surgery ward (F3B) in Tuen Mun Hospital. All in-patients in the ward would be recruited. Participants had existing ear skin loss would be excluded and all participants could quit the study whenever they want. The study was divided into 2 phases. In the phase 1, participants put on conventional hospital-provided surgical masks while silicone tape applied onto left ear (Silicone group) and hydrocolloid sheet applied onto right ear (Hydrocolloid group). In the phase 2, participants put on hospital-provided surgical masks with modified ear loop while silicone tape applied onto left ear (Silicone-Modified-Ear-Loop group) and no dressing application on right ear (Modified-Ear-Loop group). Participant’s ear skin condition was rated: Intact skin scored 3; Mildly erythematous scored 2; Moderately erythematous (sign of Stage 1 Pressure Injury) scored 1; Deeply erythematous (sign of Deep Tissue Pressure Injury) scored 0; and pain score (NRS 0 – 10) was ongoing monitored before and after 3-day study in both phases. Statistical analysis was carried out using SPSS Version 25.0. Skin condition variables were compared using repeat measure ANOVA while p< 0.05 was considered significant.
Result & Outcome :
During the study period (phase 1 from 3 November 2020 – 6 November 2020; phase 2 from 24 November 2020 – 27 November 2020), 46 patients were recruited and 35 patients (n=35) completed the study. 11 patients declined due to discharge prior study completion. No skin complication was reported. 83.3% (n=20) and 68.2% (n=15) patients completed phase 1 and 2 study respectively. Silicone group had skin condition improved from mean score 1.77 to 2.38 (p=0.013) at otobasion superius. Hydrocolloid group had skin condition improved from mean score 2.08 to 2.31 (p=0.267) at otobasion superius. Modified-Ear-Loop group had skin condition improved from mean score 1.40 to 2.40 (p=0.002) at otobasion superius and Silicone-Modified-Ear-Loop group had skin condition improved from mean score 1.45 to 2.45 (p=0.001) at otobasion superius. All groups showed pain level reduction.
All groups produced positive outcomes in terms of skin condition improvement and pain level reduction. Silicone tape, as prophylactic dressing, applied onto ear seemed to have more superior performance than hydrocolloid dressing in MDRPI prevention. Modification of surgical mask ear loop by reduced its elasticity and friction was also feasible to reduce induced injury as shown by this study. It could be an alternative method especially in the settings where certain advanced dressing materials were unavailable. All groups showed very satisfactory pain reduction effect.
Moreover, increase awareness, early identification of at-risk patients and implementation of appropriate interventions were believed to achieve improvement in patient compliance and reduce the incidence of injury.
