Occupational dermatoses among front-line health care workers during the COVID-19 pandemic: A cross-sectional survey

Abstract

To the Editor: High rates of occupational dermatoses related to hand hygiene and personal protective equipment (PPE) have been reported during the COVID-19 pandemic in China and Germany.1Yan Y. Chen H. Chen L. et al.Consensus of Chinese experts on protection of skin and mucous membrane barrier for health-care workers fighting against coronavirus disease 2019.Dermatol Ther. 2020; https://doi.org/10.1111/dth.13310Crossref Scopus (191) Google Scholar, 2Pei S. Xue Y. Zhao S. et al.Occupational skin conditions on the frontline: a survey among 484 Chinese healthcare professionals caring for Covid-19 patients.J Eur Acad Dermatol Venereol. 2020; 34: e354-e357Crossref PubMed Scopus (28) Google Scholar, 3Lan J. Song Z. Miao X. et al.Skin damage among health care workers managing coronavirus disease-2019.J Am Acad Dermatol. 2020; 82: 1215-1216Abstract Full Text Full Text PDF PubMed Scopus (291) Google Scholar, 4Guertler A. Moellhoff N. Schenck T.L. et al.Onset of occupational hand eczema among healthcare workers during the SARS-CoV -2 pandemic—comparing a single surgical site with a COVID -19 intensive care unit.Contact Dermatitis. 2020; 83: 108-114Crossref PubMed Scopus (66) Google Scholar Based on the increased need for PPE and hand hygiene, we suspected occupational dermatoses to be a common problem among US health care workers during the COVID-19 pandemic. Our aim was to better understand the burden and impact of occupational dermatoses among health care workers during the COVID-19 pandemic, including missed work, sleep disturbance, and modification of PPE due to related skin symptoms. This study was reviewed and deemed exempt by the Boston Medical Center (BMC) Institutional Review Board. Cross-sectional data were obtained via a secure anonymous electronic questionnaire administered to health care workers at Boston Medical Center between May 2, 2020, and May 10, 2020. Participants included physicians, nurses, and other allied health professionals. This survey assessed new and existing skin problems reported by participants. Table I summarizes participant characteristics and responses. Of the 390 participating health care workers, 341 were women (87.4%); the mean (standard deviation) age was 39.5 (12.1) years. The high proportion of female participants is similar to the majority proportion of women in the health care workforce in the United States.5Cheeseman Day J. Christnacht C. Your Health Care Is in Women's Hands. U.S. Census Bureau, 2019Google Scholar Of the 235 participants who reported an existing skin condition before the start of the pandemic, 145 (61.7%) experienced worsening of their skin condition (Supplemental Fig 1; available via Mendeley at https://doi.org/10.17632/hk7hvzdn6j.1). Nearly all participants reported developing new skin symptoms since the start of the pandemic (372 [95.4%]) and new skin problems after the use of PPE (353 [90.5%]) (Fig 1 and Supplemental Fig 2; available via Mendeley at https://doi.org/10.17632/hk7hvzdn6j.1). The majority of participants reported modifying PPE to prevent or alleviate skin problems (254 [65.1%]), and many were concerned that the modifications may have interfered with PPE effectiveness (96 [24.6%]). Two (0.5%) participants reported missing work due to skin symptoms since the pandemic began. Many participants reported experiencing sleep disruption (63 [16.2%]); anxiety, annoyance, or frustration (275 [70.5%]); and embarrassment, shame, or isolation (101 [25.9%]) associated with their new or worsening skin problems. Some participants reported new or worsening nail biting (63 [16.2%]), and some participants reported new or worsening skin picking (140 [35.9%]).Table IOccupational characteristics and participant responsesCharacteristicsn (%)Occupational characteristics DepartmentOther107 (27.4)Emergency medicine78 (20.0)Pulmonary/critical care59 (15.1)Internal medicine38 (9.7)Surgery33 (8.5)Family medicine20 (5.1)Other specialty pulled to internal medicine/ICU20 (5.1)Medicine subspecialty (excluding pulmonary/critical care)16 (4.1)Anesthesia8 (2.1)Surgical subspecialty5 (1.3) Occupational settingInpatient floor132 (33.8)Intensive care98 (25.1)Emergency department83 (21.3)Stepdown unit21 (5.4)Other21 (5.4)Outpatient16 (4.1)Operating room10 (2.6)Telemedicine5 (1.3)Urgent care1 (0.3) OccupationNurse247 (63.3)Resident28 (7.2)Other24 (6.2)Attending22 (5.6)Nursing assistant21 (5.4)Respiratory therapist10 (2.6)Pharmacist7 (1.8)Physician assistant7 (1.8)Fellow6 (1.5)Intern6 (1.5)Case manager3 (0.8)CRNA3 (0.8)Medical assistant3 (0.8)Social worker2 (0.5) Worked with patients with confirmed or suspected COVID-19351 (90.0)Participant responses Missed work due to skin symptoms2 (0.5) Anxious, annoyed, or frustrated by skin symptoms275 (70.5) Skin symptoms interfered with sleep63 (16.2) Embarrassed, ashamed, or isolated by skin symptoms101 (25.9) New or worsening nail biting63 (16.2) New or worsening skin picking140 (35.9) Modification of PPE254 (65.1) Concerned modifications affected PPE efficacy96 (24.6) Purchased new skin care products194 (49.7) Interested in obtaining advice from a dermatologist192 (49.2)CRNA, Certified registered nurse anesthetist; ICU, intensive care unit; PPE, personal protective equipment. Open table in a new tab CRNA, Certified registered nurse anesthetist; ICU, intensive care unit; PPE, personal protective equipment. Our study has some limitations. It is likely that employees with skin complaints participated at higher rates, so our findings cannot be used to approximate the prevalence of any of the measures we reported. Additionally, this survey was conducted electronically and in English, excluding non–English speakers and those without access to internet-enabled devices. Despite these limitations, this study provides insight into the skin problems faced by health care workers in the setting of increased PPE use, increased hand hygiene, and the stress of working during the COVID-19 pandemic. Our findings show that many front-line health care workers reported new or worsening skin problems since the start of the COVID-19 pandemic, that health care workers attributed skin problems to the use of PPE, and that health care workers modified PPE to alleviate skin problems. Further research is necessary to determine how users are modifying their PPE and whether these modifications compromise PPE efficacy.