ORIGINAL ARTICLE Year : 2022  |  Volume : 42  |  Issue : 1  |  Page : 16-20

Evaluation of skin damage owing to protecting measures against COVID-19 among health staff in the west of Iran

Ensiyeh Jenabi1, Mohammad R Sobhan2, Saeid Bashirian3, Ali Poormohammadi4, Tahereh V Najafi5, Salman Khazaei6
1 Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
2 Department of Dermatology, School of Medicine, Psoriasis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
3 Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
4 Center of Excellence for Occupational Health, Research Center for Health Sciences, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
5 Department of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
6 Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran

Date of Submission08-Jul-2020Date of Acceptance27-Aug-2020Date of Web Publication18-Dec-2021

Correspondence Address:
PhD Salman Khazaei
Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Postal Code: 6517838678
Iran

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ejdv.ejdv_41_20

Background So far, studies have not been performed regarding skin damage owing to protective measures against coronavirus disease 2019 (COVID-19) by health staff in Iran. Therefore, the present study was performed to assess skin damages owing to protecting measures against COVID-19 among health workers in Hamadan City located in the west of Iran.
Materials and methods This cross-sectional study was conducted on 273 health staff working in hospitals affiliated to Hamadan University of Medical Sciences. The inclusion criteria were health personnel working in hospitals involved in the care and treatment of patients with COVID-19 in the city of Hamadan. The authors used a researcher-developed questionnaire to gather data. All the analyses were done using Stata version 14-2. P value less than 0.05 was considered as significant.
Results The most common skin signs and symptoms of COVID-19 in health staff were dryness, redness, and itch, representing in 83.78, 53, and 40.99% of hospital staff, respectively. All participants used hand disinfectants, with a frequency in the range of 1–5 times in 29.33% and more than 20 times in 19.79% of them. Using a mask for more than 6 h in daily practice was significantly associated with skin dryness (P=0.007), skin redness (P=0.001), scaling (P=0.019), and skin pain (P=0.005).
Conclusion The findings showed that the prevalence of skin damages related to using protective equipment is high, and simple interventions may help preserve health workers to care for patients infected by COVID-19.

Keywords: coronavirus disease 2019, protecting measures, skin damage

How to cite this article:
Jenabi E, Sobhan MR, Bashirian S, Poormohammadi A, Najafi TV, Khazaei S. Evaluation of skin damage owing to protecting measures against COVID-19 among health staff in the west of Iran. Egypt J Dermatol Venerol 2022;42:16-20
How to cite this URL:
Jenabi E, Sobhan MR, Bashirian S, Poormohammadi A, Najafi TV, Khazaei S. Evaluation of skin damage owing to protecting measures against COVID-19 among health staff in the west of Iran. Egypt J Dermatol Venerol [serial online] 2022 [cited 2021 Dec 18];42:16-20. Available from: http://www.ejdv.eg.net/text.asp?2022/42/1/16/332673   Introduction 

Coronavirus disease 2019 (COVID‐19) has rapidly spread around the world. Therefore, hospital workers need to be prepared for patients in their communities. Continuing to wear protective equipment against skin damages can be difficult, and trying to change pressure and abrasion spots may reduce the effect of the protective mask. Hospital workers were vulnerable to skin and mucosa barrier breakdown due to frequent cleansing and long‐term use of personal protective equipment. These preventive measures can cause dermatitis, secondary infections, and aggravation of skin damage.

The results study showed that 71% of worker hospitals reported self‐perceived skin damage. The symptoms were burning, itch, and stinging. Most types of damage were dryness or scales, papule, erythema, and maceration [1]. Meding et al. [2] in Sweden in a cohort study reported that prolonged water exposure induces skin irritation.

The frequency of hand washing, wet work, glove use, and duration of employment are important risk factors for hand dermatitis among hospital personnel [3]. Yan et al. [4] reported that insufficient and excessive protection will have adverse effects on the skin and mucous membrane barrier.

Lan et al. [5] reported that the prevalence of skin damage among health care workers related to enhanced prevention measures was 97.0%. This damage was cutaneous lesions affecting the nasal bridge, hands, cheek, and forehead. The most affected site (83.1%) was the nasal bridge. Moreover, the frequent hand hygiene was related with a higher incidence of hand dermatitis.

So far, studies have not been performed about skin damage owing to protecting measures against COVID-19 among health workers in Iran. Therefore, the present study was performed to assess the skin damages owing to protecting measures against COVID-19 among health workers in Hamadan City located in the west of Iran.

  Materials and methods 

This cross-sectional study was conducted on 273 health staff working in hospitals affiliated to Hamadan University of Medical Sciences from March 1, 2020, to May 15, 2020. The Ethics Committee of Hamadan University of Medical Sciences approved this study.

The inclusion criteria were health personnel working in hospitals involved in the care and treatment of patients with COVID-19 in the city of Hamadan.

We used a researcher-developed questionnaire including demographic characteristics; use of protective equipment against COVID-19 infection such as mask, glasses, shield, and protective cloth; and common skin signs and symptoms of COVID-19 infection such as papule, vesicles, cracks, itch, redness, dryness, scaling, pain, and urticarial.

The qualitative data were summarized with frequency and percentage and quantitative variables with mean±SD. Statistical analysis was performed used the χ2 tests for assessing the relation between skin signs and symptoms of COVID-19 infection in health stuff and duration of use of protective equipment. All the analyses were done used Stata version 14-2 (StataCorp, College Station, TX, USA). P value less than 0.05 was considered as significant.

  Results 

In the present study, 273 hospital staff were recruited. The baseline characteristics of the study population are presented in [Figure 1]. A total of 185 (65.37%) participants were nurses and 175 (61.84%) participants had bachelor’s degrees. Moreover, 70.2% of the participants were women and only eight (2.83%) of them were over 50 years old (an overall average age of 34.1+6.85 years, 33.08 years for men, 4.51 years for women).

As shown in [Figure 2], the most common skin signs and symptoms of COVID-19 in health staff were dryness, redness, and itch, present in 83.78, 53, and 40.99% of hospital staff, respectively.

Figure 2 Common skin signs and symptoms of coronavirus disease 2019 infection in health stuff.

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The percentage use of protective equipment against COVID-19 infection in hospital staff is presented in [Table 1]. As can be seen here, 19.79, 13.17, and 10.28% of them never use masks, glasses, and shields during work activities, respectively.

Table 1 Using protective equipment against coronavirus disease 2019 infection in health stuff

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All participants used hand disinfectants with a frequency in the range 1–5 times in 29.33% and more than 20 times in 19.79% of them.

Most of the organs with skin damaged related to the use of protective equipment included hands and nose, in 212 (74.91%) and 169 (59.72%) of the personnel, respectively. The common skin signs or symptoms of COVID-19 infection in the nose were dryness and redness in 55.12 and 38.16% of staff, respectively. Approximately 68.9 and 37.46% of them experienced dryness in their hands and cheek, respectively ([Table 2]).

Table 2 Skin signs and symptoms of coronavirus disease 2019 infection in health stuff based on body organ

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The relation between skin signs and symptoms of COVID-19 infection in hospital staff and duration used of protective equipment is shown in [Table 2]. As observed here, using a mask for more than 6 h in daily activity was significantly associated with skin dryness (P=0.007), skin redness (P=0.001), scaling (P=0.019), and skin pain (P=0.005). On the contrary, using protecting cloths for more than 6 h in daily activity was associated with skin redness in the studied hospital staff (P=0.001).

  Discussion 

Nowadays, a novel coronavirus (SARS-CoV-2) with high pathogenicity and transmissibility in human has emerged as a public health concern worldwide [6]. SARS-CoV-2 is associated with high mortality and mortality. According to the recent studies, this new coronavirus can remain infectious on all inanimate surfaces for up to nine days, which highlights the role of frequent disinfection of surfaces and hand washing, especially in hospitals with high density of COVID-19-infected patients [7]. Medical staff are in direct contact with patients and hence the long-term and frequent use of protective measures may pose a health risk to them. Skin problems are one of the most common complaints regarding the use of protective equipment among health care staff [8],[9]. In this regard, the present study aimed at investigating skin damages caused by long-term use of protective equipment and disinfectants among health care workers in Hamadan Hospitals, Hamadan, Iran. As mentioned before, a researcher-made questionnaire was used to evaluate the demographic characteristics, such as age, occupation, and education; use of protective equipment, including gloves, goggles, face shields, and masks; and the skin lesions such as papule, urticaria, eczema, erythema and desquamation, among health staff of Hamadan Hospitals, Hamadan, Iran. According to the results obtained, dryness was identified as the most common complication regarding the use of protective equipment among the studied health care staff. As observed in [Figure 2], 83.78% of the health care staff had skin dryness, which can be attributed to the frequent use of hand washing solutions during work shifts in hospitals. Skin redness was identified as the second most common skin complication among health care staff, which is mainly attributed to the long-term use of face mask, especially those who were using respirators. Previous studies have reported that the long-term use of face respirators is associated with skin injuries such as excess skin hydration and pressure ulcers [10]. Moreover, itch, scaling, pain, cracks, urticarial, papule, and vesicle were also observed among the studied health care workers. In a similar study, the prevalence rate of skin damage among the first-line health care workers was reported to be 97%, in which the nasal bridge, hands, cheek, and forehead were the most affected organs. In the study by Lan et al. [5], the nasal bridge with a prevalence of 83.1% was the most affected site in the health care workers. Based on the results, most of the studied health workers had face mask for more than 6 h. It can be a reason for the increase of skin damage in this group. Moreover, most of the participants were using glass and shield on their face during the shift, which may be attributed to the increase of skin damage among them. As observed in [Table 3], the highest rate of dryness skin was observed in the hands of the studied staff, which is mainly owing to long-term use of hand-washing solutions during the shift. Continuous use of latex medical gloves may be another reason for the increase of skin damage in the hands of the studied staff. After that, 55.12% of studied staff experienced dryness in the nose during shift, which is related to the use of face mask. As can be seen, 37.46% of dryness was observed in cheek of the health care workers, which emphasizes the role of wearing mask on skin discomfort in this area of the face. The results demonstrated that using mask for more than 6 h in daily activity was significantly associated with skin dryness, skin redness, scaling and skin pain. On the contrary, using protecting clothes for more than 6 h in daily activity was associated with skin redness in the studied hospital staff. This finding clearly indicated that long-term use of protective equipment can increase the symptoms and skin damages in the stuff. Therefore, it seems that the staff should only use the protective equipment in high-risk wards of health care sittings during work time and prevent over-use of this equipment to avoid and decrease adverse the skin effects. In this regard, Zhu et al. [11] showed that long-term use of N95 respirator and surgical face mask among health care staff can cause nasal physiological changes, which is consistent with our findings. The lowest rate of the skin symptoms was observed in the feet and trunk, which is clearly related to the lack of exposure to the disinfectants and lack of direct contact with the protective equipment. As mentioned before, the studied health care workers experienced a wide range of skin symptoms in their hands, including dryness, redness, and itch with a high frequency; scaling, pain, and cracks with a moderate frequency; and urticarial, papule, and vesicles with a low frequency. This is in agreement with the results of Hamnerius et al. [12] study. Therefore, in these health workers, hands were identified as a vulnerable organ, and protective measures should be considered to prevent further skin damage. Some of these measures include the use of less sensitive gloves and hand disinfectant gels containing moisturizers and emollients. In a previous study, it has been reported that glove‐related symptoms are common in health care workers in Hong Kong. Gloved health care workers are at risk of becoming sensitized to latex, and those with positive latex skin tests, long glove exposure time, and frequent glove changes are at risk of clinical latex allergy [13]. This is consistent with our findings regarding the use of protective equipment and skin problems in hands of health workers. Moreover, Rebmann et al. [14] in a similar study reported that long-term use of respiratory protection is associated with many subjective symptoms and physiologic measures in health care staff. This study was performed based on self-reported data by health workers, and this was the limitation of the present study.

Table 3 The relation between skin signs and symptoms of coronavirus disease 2019 infection in health stuff and duration of use of protective equipment

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  Conclusion 

Our findings showed that the prevalence of skin diseases related to protective equipment is high, and simple interventions may help preserve health workers to care for patients infected by COVID-19.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

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  [Table 1], [Table 2], [Table 3]