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Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus: A Quality Improvement Project.
J Wound Ostomy Continence Nurs. 2020 Nov/Dec; 47(6):551-557.JW

Abstract

PURPOSE

Extended use of N95 respirator masks is far more prevalent during the coronavirus disease 2019 (COVID-19) pandemic. As WOC nurses, we were tasked with formulating procedures for protecting the facial skin integrity of healthcare workers (HCWs) using personal protective devices when caring for patients with suspected or active COVID-19, while avoiding contamination when the masks are donned or doffed. This quality improvement project describes how we approached this project within the limited time frame available as we cared for patients with established and suspected COVID-19.

PARTICIPANTS AND SETTING

This project focused on HCW use of N95 respirator masks and dressings currently available in our facility. The 4 WOC nurses acted as quality improvement project directors and as participants. The setting for our project was our facility's simulation laboratory.

APPROACH

We evaluated 6 topical products (an alcohol-free liquid acrylate, thin film dressing, thin hydrocolloid dressing, hydrocolloid blister care cushion, thin foam transfer dressing, and thick foam dressing) applied to skin in contact with 3 N95 respirators; all are available on our facility's formulary and all are in widespread clinical use. After the product was applied to the face and nose, the N95 respirator was donned and evaluated for fit. Participants then wore the devices for 10 hours and doffed the mask using established facility procedures. In order to evaluate for potential contamination including possible aerosolization, we applied a commercially available fluorescent lotion to simulate the presence of infectious particles. Contamination was assessed using an ultraviolet light for all dressings except for the alcohol-free liquid acrylate. We also evaluated cutaneous responses (skin integrity, irritation, comfort) during this period.

OUTCOMES

We found that contamination of the simulated pathogen did not occur with removal of any of the protective products. No skin irritation was noted with any of the tested products after a 10-hour wear time underneath the N95 respirator masks, but mild discomfort was experienced with 3 of the dressings (thin film dressing and both hydrocolloid dressings).

CONCLUSION

Based on these experiences, we recommend application of an alcohol-free liquid acrylate film to prevent facial skin injury associated with friction from the extended use of an N95 respirator mask. We further recommend performing a fit test and user-performed seal check with the use of any topical dressing and especially those that add cushion. For the duration of the COVID-19 pandemic, we recommend use of protective dressings to maintain skin integrity and protection from coronavirus infection as HCWs continue to provide care to all of patients under their care.

Authors+Show Affiliations

Michelle Pacis, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Annielyn Azor-Ocampo, MSN, RN, CWOCN, DAPWCA, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Emily Burnett, MSN, RN, CNL, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Chutiwan Tanasapphaisal, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Bernice Coleman, PhD, ACNP-BC, FAHA, FAAN, Department of Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California.Michelle Pacis, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Annielyn Azor-Ocampo, MSN, RN, CWOCN, DAPWCA, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Emily Burnett, MSN, RN, CNL, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Chutiwan Tanasapphaisal, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Bernice Coleman, PhD, ACNP-BC, FAHA, FAAN, Department of Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California.Michelle Pacis, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Annielyn Azor-Ocampo, MSN, RN, CWOCN, DAPWCA, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Emily Burnett, MSN, RN, CNL, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Chutiwan Tanasapphaisal, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Bernice Coleman, PhD, ACNP-BC, FAHA, FAAN, Department of Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California.Michelle Pacis, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Annielyn Azor-Ocampo, MSN, RN, CWOCN, DAPWCA, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Emily Burnett, MSN, RN, CNL, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Chutiwan Tanasapphaisal, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Bernice Coleman, PhD, ACNP-BC, FAHA, FAAN, Department of Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California.Michelle Pacis, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Annielyn Azor-Ocampo, MSN, RN, CWOCN, DAPWCA, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Emily Burnett, MSN, RN, CNL, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Chutiwan Tanasapphaisal, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California. Bernice Coleman, PhD, ACNP-BC, FAHA, FAAN, Department of Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33201140

Citation

Pacis, Michelle, et al. "Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers when Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus: a Quality Improvement Project." Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society, vol. 47, no. 6, 2020, pp. 551-557.
Pacis M, Azor-Ocampo A, Burnett E, et al. Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus: A Quality Improvement Project. J Wound Ostomy Continence Nurs. 2020;47(6):551-557.
Pacis, M., Azor-Ocampo, A., Burnett, E., Tanasapphaisal, C., & Coleman, B. (2020). Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus: A Quality Improvement Project. Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society, 47(6), 551-557. https://doi.org/10.1097/WON.0000000000000713
Pacis M, et al. Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers when Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus: a Quality Improvement Project. J Wound Ostomy Continence Nurs. 2020 Nov/Dec;47(6):551-557. PubMed PMID: 33201140.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus: A Quality Improvement Project. AU - Pacis,Michelle, AU - Azor-Ocampo,Annielyn, AU - Burnett,Emily, AU - Tanasapphaisal,Chutiwan, AU - Coleman,Bernice, PY - 2020/11/17/entrez PY - 2020/11/18/pubmed PY - 2020/11/27/medline SP - 551 EP - 557 JF - Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society JO - J Wound Ostomy Continence Nurs VL - 47 IS - 6 N2 - PURPOSE: Extended use of N95 respirator masks is far more prevalent during the coronavirus disease 2019 (COVID-19) pandemic. As WOC nurses, we were tasked with formulating procedures for protecting the facial skin integrity of healthcare workers (HCWs) using personal protective devices when caring for patients with suspected or active COVID-19, while avoiding contamination when the masks are donned or doffed. This quality improvement project describes how we approached this project within the limited time frame available as we cared for patients with established and suspected COVID-19. PARTICIPANTS AND SETTING: This project focused on HCW use of N95 respirator masks and dressings currently available in our facility. The 4 WOC nurses acted as quality improvement project directors and as participants. The setting for our project was our facility's simulation laboratory. APPROACH: We evaluated 6 topical products (an alcohol-free liquid acrylate, thin film dressing, thin hydrocolloid dressing, hydrocolloid blister care cushion, thin foam transfer dressing, and thick foam dressing) applied to skin in contact with 3 N95 respirators; all are available on our facility's formulary and all are in widespread clinical use. After the product was applied to the face and nose, the N95 respirator was donned and evaluated for fit. Participants then wore the devices for 10 hours and doffed the mask using established facility procedures. In order to evaluate for potential contamination including possible aerosolization, we applied a commercially available fluorescent lotion to simulate the presence of infectious particles. Contamination was assessed using an ultraviolet light for all dressings except for the alcohol-free liquid acrylate. We also evaluated cutaneous responses (skin integrity, irritation, comfort) during this period. OUTCOMES: We found that contamination of the simulated pathogen did not occur with removal of any of the protective products. No skin irritation was noted with any of the tested products after a 10-hour wear time underneath the N95 respirator masks, but mild discomfort was experienced with 3 of the dressings (thin film dressing and both hydrocolloid dressings). CONCLUSION: Based on these experiences, we recommend application of an alcohol-free liquid acrylate film to prevent facial skin injury associated with friction from the extended use of an N95 respirator mask. We further recommend performing a fit test and user-performed seal check with the use of any topical dressing and especially those that add cushion. For the duration of the COVID-19 pandemic, we recommend use of protective dressings to maintain skin integrity and protection from coronavirus infection as HCWs continue to provide care to all of patients under their care. SN - 1528-3976 UR - https://www.unboundmedicine.com/medline/citation/33201140/Prophylactic_Dressings_for_Maintaining_Skin_Integrity_of_Healthcare_Workers_When_Using_N95_Respirators_While_Preventing_Contamination_Due_to_the_Novel_Coronavirus:_A_Quality_Improvement_Project_ L2 - https://doi.org/10.1097/WON.0000000000000713 DB - PRIME DP - Unbound Medicine ER -