Sept. 2, 2020 Prevention and Management of Skin Injury from PPE 1
Quick Reference Guide Prevention & Management of Skin Injury from Personal Protective Equipment
(PPE)
Prevention of Skin Injury (See product examples on Page 2) PPE selection: Use the PPE appropriate to Zone (Red, Orange, or Green) Skin Care at Home: Hands: Apply moisturizer or barrier cream with Dimethicone, silicone, ceramides or ointment with petrolatum*. *Avoid use of petrolatum based hand lotion when using latex gloves Face: Prevent/treat acne breakouts by washing face with pH balanced soap & moisturizing. Avoid application of make-up over affected areas. Skin Care at Work: Pressure relief: Remove PPE to relieve pressure on the skin appropriate to Zone. If a dressing is used, leave in place if intact until end of shift. Consider a holding device or dressing to relieve pressure behind ears. Skin inspection end of shift: Upon removal of PPE, & protective dressing if in place, inspect skin for injury or irritation. Once at home after proper hand washing, face & neck should be thoroughly cleansed using pH balanced soap & water. Dry face & neck, moisturize hands & face. Surgical Masks: Do not apply undue pressure when applying PPE, while still ensuring a tight seal. N95 Respirators: Consider a dressing if indicated in chart below. Management of Skin Injury 1. Report skin injury or irritation as per site work related injury/illness process to Occupational Health or
designate 2. Do not rub any areas which may have been under pressure, as this may increase damage. 3. Do not apply moisturizer over areas of skin breakdown, consider a dressing.
Hands at home Hands at work: Moisture & Irritation from Gloves Contact Occupational Health or designate
Prevention & Treatment Prevention Treatment Use mild pH balanced soap Regular & frequent application of moisturizer
Dry hands thoroughly Avoid jewelry & wrist watches Barrier wipe Moisturizer
Barrier wipe Moisturizer
Face: Surgical Masks, Goggles, Eye & Face Shields, N95 Respirators, Half Mask Respirators Contact Occupational Health or designate
Level of Skin Injury
Surgical mask, goggles, eye & face shield
N95 Respirator
Intact skin - Redness prevention
Barrier wipe Barrier wipe
Intact skin - Non blanchable redness persists (Stage 1 Pressure Injury)
See Page 3 for dressing placement Thin hydrocolloid sheet or Thin non-bordered silicone foam
Barrier wipe See list of mask types on Page 2 for dressing compatibility See Page 3 for dressing placement
Skin breakdown - Blister open or intact (Stage 2 Pressure Injury)
Bordered thin silicone foam dressing
Contact Occupational Health or designate
Sept. 2, 2020 Prevention and Management of Skin Injury from PPE 2
N95 Respirator Type Possible solutions
Remind staff they must check the seal each time they don a respirator by performing a user seal check. 3M N95 Aura OS 1870+
DO NOT use dressing
3M N95 1860S DO NOT use dressing
3M N95 1860 DO NOT use dressing
3M N95 Vflex S 1804S
DO NOT use dressing
3M N95 Vflex Reg. 1804
DO NOT use dressing
3M N95 8210 DO NOT use dressing
AO Safety N95 PleatsPlus S/M
Thin non-bordered silicone foam
AO Safety N95 PleatsPlus M/L
Thin non-bordered silicone foam
Kimberly Clark N95 Small
DO NOT use dressing
Kimberly Clark N95 Regular
DO NOT use dressing
Moldex N95 OS DO NOT use dressing
North 7130 Small Thin non-bordered silicone foam
North 7130 Regular DO NOT use dressing
1/2Mask 7501 S Adjust top straps first, & then lower neck straps by pulling on ends. DO NOT over-tighten. Strap tension may be decreased by pushing out on back side of buckles. DO NOT use dressing
1/2Mask 7502 M
1/2Mask 7503 L
1/2Mask 6501 S
1/2Mask 6300 L
Product Category Product Suggestions
Barrier Wipe 1ml 3M™ Cavilon™ No Sting Barrier Wipe 1ml No-Sting™ Skin-Prep protective wipe
Hydrocolloid 15x15cm Comfeel ® Plus Transparent 14x14cm Duoderm® Extra thin hydrocolloid
Thin non-bordered silicone foam
15x15cm Mepilex® Lite
Bordered foam 4x5cm Mepilex ®Border Lite
Important tips Barrier film must be allowed to dry for 1 minute before donning PPE Dressings should not be stretched but gently molded to fit contours of nose and cheeks. Hydrocolloids are adhesive and must be removed gently, holding skin below Thin non-bordered silicone foam has a low tack (gentle adhesive) to hold in place
Nose and cheeks
Forehead
Ears: Note 1cm might be too small for good fit see template on Page 4
Sept. 2, 2020 Prevention and Management of Skin Injury from PPE 3
Goggles eye & face shields Thin hydrocolloid or Thin non-bordered silicone foam
Surgical mask & specified N95 respirators Thin hydrocolloid or Thin non-bordered silicone foam
Surgical mask Holding device
Surgical mask Thin hydrocolloid or Thin non-bordered silicone foam
Sept. 2, 2020 Prevention and Management of Skin Injury from PPE 4
Dressing templates (actual size)
Forehead
Nose and cheeks
Ear Ear
Sept. 2, 2020 Prevention and Management of Skin Injury from PPE 5
Premise of document This document was developed by Kari Mann CNS for Skin and Wound at Health Sciences Centre and Jane McSwiggan Education and Research Coordinator, Winnipeg Regional Health Authority (WRHA) in response to the development of staff skin injuries from the use of personal protective devices (PPEs) being worn on the face and irritation to hands from gloves . Using materials and documents produced by Nurses Specialized in Ostomy and Continence Nursing Canada (NSWOC), APTFeridas, the Portuguese Wound Care Association, the National Pressure Injury Advisory Panel (NPIAP), and in consultation with Darren Nowakowski, Safety Coordinator, WRHA Occupational and Environmental, Health & Safety it was determined that N95 respirators should be fit tested with dressings to see if a seal can be achieved. As per current practice, staff must still perform a proper positive and negative seal check after each donning to ensure protection. The listed N95 respirators have been fit tested quantitatively using Portacount Pro Plus model 8038. It is important to note that a respirator which did not seal with a dressing also did not seal without a dressing, therefore a different model of respirator had to be fitted. Of note, the thin hydrocolloid and thin non-bordered silicone foam dressing are very thin and flexible dressings which easily conform to the face. References
Alves, P., Moura, A., Vaz, A., Ferreira, A., Malcato, E, Mota, E. et al. (2020). PRPPE guideline Covid 19:
Prevention of skin lesions caused by personal protective equipment. [White Paper]. Journal of Tissue Healing and Regeneration. Retrieved from https://dsr.dk/sites/default/files/50/recomendation_prppe_covid19_ing_1.pdf
LeBlanc, K., Heerschap, C., Butt, B., Bresnai-Harris, J., & Wiesenfeld, L. (2020). Prevention and management
of personal protective equipment skin Injury: Update 2020, NSWOCC. Retrieved from www.nswoc.ca/ppe.
National Pressure Injury Advisory Panel. (2020). NPIAP position statements on preventing injury with N95 masks. Retrieved from https://cdn.ymaws.com/npiap.com/resource/resmgr/position_statements/Mask_Position_Paper_FINAL_fo.pdf