Journal of Wound CareVol. 29, No. 7 DRPU COVID-19 UpdateFree AccessPrevention of skin damage caused by the protective equipment used to mitigate COVID-19: monthly updateAmit Gefen, Karen OuseyAmit GefenCorresponding author email: E-mail Address: [email protected]Professor of Biomedical Engineering and the Herbert J. Berman Chair in Vascular Bioengineering; Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, IsraelSearch for more papers by this author, Karen OuseyCorresponding author email: E-mail Address: [email protected]Professor and Director for the Institute of Skin Integrity and Infection Prevention; School of Human and Health Sciences, University of Huddersfield, Queensgate, West Yorkshire, UKSearch for more papers by this authorAmit Gefen; Karen OuseyPublished Online:12 Jul 2020https://doi.org/10.12968/jowc.2020.29.7.379AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail Globally, as the pandemic begins to come under control and health professionals begin reviewing how this has affected patients and their skin integrity, we should begin to see reliable incidence and prevalence figures published. It will be a time to reflect and review how to manage skin integrity when the next peak returns. Interventions must include education of all health professionals, patients and their carers as to how to prevent skin damage and when to refer to specialist teams for advice. We must increase our awareness of symptoms associated with COVID-19 and how these have the potential to adversely affect the skin. COVID-19 may be retreating but we do not know if infections will increase again as winter returns (to the Northern Hemisphere)—we will be watching and waiting.COVID research, evidence, comment pieces, discussion papers and letters to editors have been published daily. In June 2020, Haghani and Bliemer1 reported that in less than five months, more than 12,000 research items on COVID-19 had been indexed, accounting for approximately 70% of all coronavirus studies published in the last 50 years, with the numbers increasing every day. Some of these papers explored and investigated skin damage caused by wearing personal protective equipment (PPE) for prolonged periods of times in addition to the increase in pressure ulcers/injuries (PU) caused by COVID debilitating patients, and the use of medical devices and the prone position.Tang et al.,2 in a letter to the editor, highlighted difficulties in effectively turning mechanically ventilated patients in intensive care units. They referred to research by Tian et al.,3 which identified diarrhoea as one of the reported common (2–49.5%) symptoms of COVID-19, warning of the potential for skin damage leading to an increase in sacral PUs—not forgetting the risk of wound infection is increased due to location of the sacral ulcer. Gefen and Ousey4 have previously discussed how loss of skin integrity creates a portal of entry for pathogens including the coronavirus itself, even on a microscopic scale.It is essential that health professionals work in an interdisciplinary manner to prevent, or identify at an early stage the potential risk of, PU development. Early preventive measures are key, including, for example, assessment of the skin visually and by means of advanced diagnostic devices, for example the sub-epidermal moisture scanner5, use of pressure redistributing devices, offloading, nutrition, pain management, and reduction of sustained tissue loads through turning and repositioning. Much has been written demonstrating positive outcomes through the use of prophylactic dressings. Peko et al.6 explored the biomechanical efficacy of using prophylactic dressings, Mepilex Border Flex (Mölnlycke, Sweden). In their paper Peko et al.6 tested and evaluated how Mepilex Border Flex interacts with facial tissues of a prone head, using a computational anatomically-realistic 3D head model that reflects the shape, composition and mechanical behaviour of both the tissues and the applied dressings. They concluded that although there are limited experimental studies in the form of clinical trials investigating prophylactic dressings in the prevention of PUs for patients in the prone position, the biomechanical evidence supports the use of these dressings to reduce facial PUs during prone positioning. They highlighted the considerable amount of time required to implement clinical trials, and in the time of public health emergencies, such as the COVID-19 pandemic, there is an urgent need to recognise and use interventions that have been proven to work through laboratory evidence and clinical feedback. The use of a soft silicone-foam, multilayered prophylactic dressing is a practical solution in clinical care, and the present computational modelling work strongly supports this approach.6 References 1 Haghani M, Bliemer MCJ. Covid-19 pandemic and the unprecedented mobilisation of scholarly efforts prompted by a health crisis: Scientometric comparisons across SARS, MERS and 2019-nCov literature. bioRxiv 2020. 2020.05.31.126813; https://doi.org/10.1101/2020.05.31.126813 Google Scholar2 Tang J, Li B, Gong J et al.. Challenges in the management of critical ill COVID-19 patients with pressure ulcer. Int Wound J 2020. https://doi.org/10.1111/iwj.13399 Crossref, Google Scholar3 Tian Y, Rong L, Nian W, He Y. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther 2020; 51(9): 843–851. https://doi.org/10.1111/apt.15731 Crossref, Medline, Google Scholar4 Gefen A, Ousey K. Prevention of skin damage caused by the protective equipment used to mitigate COVID-19. J Wound Care 2020; 29(6):311. https://doi.org/10.12968/jowc.2020.29.6.311 Link, Google Scholar5 Gefen A, Ross G. The subepidermal moisture scanner: the technology explained. J Wound Care 2020; 29(Sup2c):S10–S16. https://doi.org/10.12968/jowc.2020.29.sup2c.s10 Link, Google Scholar6 Peko L, Barakat-Johnson M, Gefen A. Protecting prone positioned patients from facial pressure ulcers using prophylactic dressings: a timely biomechanical analysis in the context of the COVID-19 pandemic. Int Wound J (in press) Google Scholar FiguresReferencesRelatedDetailsCited ByWounds Week: 27–31 July17 August 2020 | Journal of Wound Care, Vol. 29, No. 8 2 July 2020Volume 29Issue 7ISSN (print): 0969-0700ISSN (online): 2052-2916 Metrics Downloaded 247 times History Published online 12 July 2020 Published in print 2 July 2020 Information© MA Healthcare LimitedPDF download