Authors (including presenting author) :
Yip KH(1), Pang YK(2)(presenting author), Siu MY(1)
Affiliation :
(1) Caritas Institute of Higher Education, School of Health Sciences
(2) Department of Surgery, Queen Elizabeth Hospital
Introduction :
In 3Q2020, more than fifty nursing professional (teaching staffs and students) of one local tertiary education institute [the School of Health Sciences Caritas Institute of Higher Education (CIHE)] had joined the community testing programme (CTP) organized by the government for early identify and cut the community transmission chain of COVID-19. After each more than 4 hours of service of duty under full personal protective equipment (PPE), most of them showed medical device related pressure injury (MDRPI) on their faces such as the bridge of nose, upper part of the cheek, above the ears, lower jaws, and double chin skin. Experts have stated that skin injury will be induced under a prolonged pressure of more than 2 hours by medical device.2,3 Another expert panel proposed to use materials includes thin foam with silicone, or in alternative with hydrocolloids and film dressing with fit-cut to face for preventing skin damage related to PPE.1 Measures on preventing and managing MDRPI among healthcare providers’ face is crucial in guarding their safety, comfort and body-image.
Objectives :
This local study is intended to investigate the effectiveness of applying prophylactic silicone containing dressing on preventing MDRPI of healthcare providers after prolonged wearing of disposable respiratory protective equipment (RPE).
Methodology :
Ethics approval was obtained from the tertiary education institute’s human research ethic committee. The first part of the study was carried out at CIHE on one Sat in Nov 2020. 2 types of silicone containing dressing available in local market, A: silicone foam with border, and B: soft silicone tape were selected. Total 34 consented nurses and student nurses (majority had participated in the CTP) were randomized into two-arms: A and B, 17 at each arm, to receive dressing A or B on nose bridge, upper cheeks and double chin skin being applied and checked by an experienced stoma & wound (S&W) care nurse. Then they had received the international certified fit test by qualified assessors before attending to a 2 hours training workshop related on prevention and management of pressure injury. A modified discomfort reporting form (score range o – 10; o=nil discomfort, 10=the most discomfort) was designed to collect participants’ subjective discomfort data and objective data by the same assessor on pain, itching, hyperemia, dryness, phlyctena, lesion such as MDRPI, and others as specify during 0 and every 30 minutes till the end of study. At the end of the study, participants’ facial condition were assessed and recorded by assessor and S&W nurse. Participants’ clinical photos were captured before and after. The second part of the study was carried out after few days; all participants whom had none facial skin lesions were invited to wear the RPE for at least 2 hours without any prophylactic dressing on face as the study control. They provided self-reported feedback and digital images for data analysis.
Result & Outcome :
At arm A and B, 1 and 9 failed in the fit test after applied the dressing were excluded in the study. Consequently 24 participants were included in a ratio of female: male 21:3 at mean age 23. The dressing were effectively reduced the hyperemia (100%) vs 54%, p < 0.001, OR = 0.07 (95% CI = 0.16 - 0.31); and MDRPI (62% vs 0%, p < 0.001, OR = 0.38 (95% CI = 0.22 - 0.63); however, the dressing created significant itch (0% vs 25%, p = 0.08, OR = 1.33 (95% CI = 1.05 - 1.68), but the level was 1.2 - 1.33 out of 10 in average, there were 2 subjects (8%) discomfort scale over 5 when 30 minutes and 4 (16%) subjects over 5 when 180 minutes. Both dressings were tolerable for prolong used in most of the subjects. Due to no dressing at the ear, the pain level (mainly compliant of pain at ear) did not significant increase or decrease (95% vs 100%), p = 0.32. Self-report feedback highlighted three main issues on comfortable perception, decrease of skin redness, and slippage of dressings after applying prophylactic dressings.
