NEW ORLEANS – Most workers at a large New York area hospital said they suffered from severe skin reactions from the personal protective equipment (PPE) they had to wear at the time as the COVID-19 pandemic was setting in, according to an investigation reported here.
Of the 148 workers who responded, ranging from respiratory therapists to doctors, 105 reported having had rashes, rashes and / or pressure sores which 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 those polled identified them as causing skin reactions, Frankel reported in a poster presentation at the American College of Allergy, Asthma, and Immunology annual meeting.
Across all equipment categories, which also included gloves, gowns, goggles, face shields and surgical masks, redness was the most frequently reported problem. But each type of PPE worn directly on the skin was also responsible for a significant number of complaints about eczema and hives.
Perhaps most concerning, 26% of all respondents said they should stop wearing PPE except during direct patient care due to skin issues.
Frankel noted that few studies of PPE-related skin reactions have been conducted in the United States during the COVID-19 era. Almost all of the existing literature predates the pandemic (for example, following the SARS outbreak of the previous decade) or comes from China’s first experience with COVID.
The NYU study may not have had the power to examine some questions, such as whether the duration of PPE use or a history of atopy or contact dermatitis were related to the incidence of skin effects. One would expect, but Frankel said there was no significant association with either of these, as survey participants reported. He said MedPage today, however, that the categories of workers with the highest incidence of PPE-related skin problems – nurses and respiratory therapists – were also those whose PPE use increased the most as the pandemic unfolded.
While N95s sparked the most complaints, surgical masks were not far behind, with 60% of workers saying they caused skin problems. In third place, gloves (around 32%), followed by face shields (30%).
Acneiform breakouts were a particular problem for N95s and surgical masks, each reported by over 40% of respondents. Frankel noted that women and workers under the age of 30 seemed most susceptible to this problem.
Gowns and goggles were the least problematic, and none of them elicited complaints from even 5% of respondents.
The investigation could not directly determine how PPE caused the skin problems, but Frankel speculated that the allergic reactions were probably less important than the physical friction of synthetic materials against the skin – the dermatitis of contact. At the same time, however, he said polypropylene is often used in medical masks and 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 the use of tissue paper and petroleum jelly on the face can do the same for respirators and masks.
Frankel did not disclose any relationship with the industry.