Audit highlights the impact of PPE and hand disinfection on the skin health of healthcare professionals during the COVID-19 pandemic
Fifty nine per cent of healthcare workers seen in occupational skin disease clinics set up during the COVID-19 pandemic were found to be affected by irritant contact dermatitis, a type of eczema, according to research being presented at the Virtual Annual Meeting of the British Association of Dermatologists (September 2020).
Increased use of personal protective equipment (PPE) and frequent hand cleansing has led to a spike of skin irritation amongst healthcare workers around the world*, particularly those on the frontline of the pandemic. Members of the British Society of Cutaneous Allergy conducted an audit of 200 hospital-based healthcare workers attending clinics for those with occupational skin disease in the UK and Ireland to describe the features of occupational skin disease during the COVID-19 pandemic.
Repeated and frequent exposure to water, soap, and alcohol hand gel, and prolonged contact with PPE can cause dry skin, and what is known as irritant contact dermatitis. The skin may start to itch, become sore and red, and develop small blisters, painful cracks (fissures) and erosions (broken skin).
On average, the healthcare workers washed their hands with soap 22.8 times per day and used alcohol hand gel 22.7 times per day. Eighteen per cent of the healthcare workers required time off work as a result of occupational skin problems, representing a significant burden on the health service during an extremely difficult time.
The duration for which PPE is worn, frequency of handwashing and use of alcohol hand gel were found to have an impact on the time off work required. Longer duration of PPE wear during a shift, and more frequent handwashing tended to increase the amount of time off and using alcohol gel did not.
Almost all the skin problems affected the face and hands. The second most common diagnosis seen in the audit was acne, caused by the occlusive effects of prolonged mask wear and seen in 15 per cent of healthcare workers. Pressure injuries related to mask wear were seen in five per cent of subjects.
Dr Isha Narang, lead researcher of the study and registrar at University Hospitals of Derby and Burton NHS Foundation, said:
“Wearing PPE for long periods can cause pressure and irritant effects on the skin and frequent handwashing with soap is drying; sometimes the effects can be bad enough to require time off work. As PPE and handwashing are essential methods of reducing the spread of COVID-19, it is important to provide healthcare workers with advice and support in managing their skin.”
Dr Harriet O’Neill, another lead researcher of the study and registrar at University Hospitals of Derby and Burton NHS Foundation, said:
“For the face, protecting the skin with medical-grade silicon tape before donning tight-fitting masks, then rechecking the fit of the mask, may be helpful. Facial skin should be regularly moisturised when not at work. Where possible, regular breaks should be taken during shifts in which the PPE, such as masks, goggles and gloves, is removed to reduce the amount of contact time with the skin. We would also recommend that people dry their hands fully after washing by patting them dry, not rubbing them. Moisturisers (emollients) are an essential part of treating dermatitis and should be applied generously after handwashing and whenever the skin feels dry. In severe cases, or if an infection is suspected, further treatment from a GP or an Occupational Health doctor may be required.”
Holly Barber, a spokesperson for the British Association of Dermatologists, said:
“PPE and frequent handwashing are essential for healthcare workers during the COVID-19 pandemic, however, the resulting skin irritation can cause enormous problems at work. Many members of the public will also have been affected by frequent handwashing, but this audit does give an indication of the spectrum of the issue for healthcare workers.
“Hopefully, these occupational skin disease clinics and skin management resources, such as the guidelines written by the British Society of Cutaneous Allergy, will help healthcare professionals manage their skin through this difficult period.”
An update on occupational skin disease, written by the British Society of Cutaneous Allergy, is available here.
Notes to editors:
* The update on occupational skin disease by the British Society of Cutaneous Allergy states that a total of 97% of 542 front-line doctors and nurses in Hubei Province, China (77.4% response rate of 700 clinical staff surveyed) were reported to have developed problems of the skin of the face and/or hands.
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The virtual conference will be held in September 2020, and is attended by approximately 1,500 UK and worldwide dermatologists and dermatology nurses.
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“Occupational dermatoses during the COVID-19 pandemic: a multicentre audit in the U.K. and Ireland”
I. Narang,1 H. O'Neill,1 D.A. Buckley,2 T.A. Phillips,3 C. Bertram,4 G.A. Johnston,5 D. Thompson,6 T. Bleiker,1 N. Stone,7 J.E. Sansom,8 S. Abdul Ghaffar,9 M.M.U. Chowdhury,10 L. Kiely,11 S.M. Cooper12 and P. Banerjee13
1University Hospitals of Derby and Burton NHS Foundation, Derby, U.K.; 2Circle Hospital, Bath, U.K.; 3Department of Statistics, University of Warwick, Coventry, U.K.; 4Royal Infirmary of Edinburgh, Edinburgh, U.K.; 5Leicester Royal Infirmary, Leicester, U.K.; 6Birmingham Skin Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, U.K.; 7Aneurin Bevan University Healthboard, Newport, U.K.; 8Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol, U.K.; 9Ninewells Hospital, Dundee, U.K.; 10The Welsh Institute of Dermatology, The University Hospital of Wales, Cardiff, U.K.; 11Cork University Hospital and South Infirmary Victoria University Hospital, Cork, Ireland; 12Oxford University Hospitals NHS Trust, Oxford, U.K.; and 13University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, U.K.
About the British Association of Dermatologists
The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. For further information about the charity, visit www.skinhealthinfo.org.uk
The British Association of Dermatologists publishes two world-renowned dermatology journals, both published by Wiley. The British Journal of Dermatology is one of the top dermatology journals in the world, and publishes papers on all aspects of the biology and pathology of the skin. https://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2133