Hygiene management // Personnel protection
22.07.2020

The main problems reported by nursing staff

In order to prevent the spread of SARS-CoV-2, nursing staff must frequently disinfect their hands and in cases of presumed or actual contact with COVID-19, they must consistently wear respirator masks, goggles or visors. A study of 542 nurses in Hubei, China investigated the effect of preventive measures on skin health.

Work-related skin conditions are widespread among health professionals. Between 20 and 30 percent of all people working in patient and elderly care develop hand eczema [1]. The main cause of this is so-called 'wet work'. Wearing gloves for long periods of time and frequent contact with water and soap compromises the natural skin barrier and leads to skin damage on the hands. During this period of coronavirus, skin conditions seem to be increasing. It is not just the hands that are affected, but also parts of the face such as the bridge of the nose, cheeks and forehead.

The bridge of the nose is affected particularly often

A study at a tertiary care hospital in Hubei, China with over 500 nurses [2] came to the conclusion that wearing different respirator masks also left marks on the nurses' skin. According to a questionnaire evaluation, 97% of those asked, who were treating COVID-19 patients, had skin problems. The most common symptoms were a feeling of tightness, dryness, flaky skin and redness. Nearly 70% complained of damage to the skin on the bridge of their nose due to wearing a FFP2 mask. The number of nurses who observed damage to the skin on the bridge of their nose increased considerably when the FFP2 mask was worn for longer than 6 hours, rising to 81.1%.

Wearing time of less than 6 hours recommended

Over half of the study participants complained of skin irritation on their forehead caused by wearing a protective visor. The number of people affected increased by 10% when the protective visors were worn for longer than 6 hours. Only gloves did not show any difference between the extent of the skin irritation and the duration of wear: even after 6 hours, the skin irritation caused by gloves was not significantly worse than after a shorter duration of wear, but it was at an overall high level of 76%.

Preventing skin damage

Hand hygiene was named as the cause of the skin irritation by 60% of the nurses who availed of up to 10 opportunities for hand hygiene. More than 10 hand hygiene opportunities led to skin irritation in almost 80% of the nurses. The study did not mention which products were used for hand hygiene. For the prevention of skin irritation on the bridge of the nose, the authors refer to another study that had positive results through the preventive use of hydrocolloid dressings.

Conclusion:

Barrier nursing with respirator masks, protective visors (if applicable) and consistent hand hygiene is essential to prevent the transmission of SARS-CoV-2 when caring for COVID-19 patients. If possible, the nursing staff should not wear the masks for longer than 6 hours. The protective effect of FFP2 masks lasts for a maximum of 8 hours. This duration of wear for FFP2 masks should only be fully utilized in case of a shortage of masks and in emergency situations.

The Robert Koch Institute [3] and the AKTION Saubere Hände [4] recommend focusing in particular on the skin compatibility of hand disinfectants. This is usually the case with comprehensively examined products, e.g. by means of VAH certification. However, on the basis of the general according to the Federal Institute for Occupational Safety and Health (Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, BAuA), not all hand disinfectants have sufficient care properties and thus sufficient skin compatibility.

Sources:

1. Skudlik C, Dulon M, Wendeler D, John SM, Nienhaus A.
Hand Eczema in Geriatric Nurses in Germany – Prevalence and Risk Factors.
Contact Dermatitis, accepted 22. Oct. 2008

2. Juan Tao. Skin damage among health care workers managing coronavirus disease-2019. Research Letter. J AM ACAD DERMATOL, Mai 2020, Volume 82, No. 5.

3. Robert Koch-Institut. Händehygiene in Einrichtungen des Gesund­heits­wesens (2016). www.rki.de. (Letzter Zugriff 21.07.2020)

4. Wissenschaftlicher Beirat der AKTION Saubere Hände. Positionspapier Verträglichkeit von Händedesinfektionsmitteln. November 2010. Letzter Zugriff 21.07.2020)

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