DiversityNursing Blog

Personal Protective Equipment (PPE) is essential for protecting healthcare workers on the frontlines of the COVID-19 pandemic. However, with prolonged use of PPE, comes skin damage.

According to a study by the Journal of American Academy of Dermatology, 97% of staff working in two different COVID-19 units reported PPE-related skin damage. The incidence increased when PPE was worn continuously for longer than six hours, and especially with N95 masks and goggles.

Hand irritation is common when frequently using gloves. The hands become irritated from constant sanitizing and hand washing. Also gloves trap moisture and heat, causing side effects such as eczema and dermatitis on hands. 

Pat hands dry or allow hands to air dry instead of rubbing to avoid further irritation. Also use warm water instead of hot because frequent use of hot water can lead to excessively dry skin. Moisturize but make sure the skin fully absorbs it before putting gloves back on. 

Nurses wearing air tight N95 and N99 masks for many hours often end up with red indentations on their faces. On the other hand, Nurses who wear non airtight masks have reported getting acne and evidence of skin irritation from pressure or chafing of the mask over the bridge of the nose.

Make sure your mask isn't too tight and is fitted comfortably on your face. You should relieve pressure regularly. If possible, try removing your mask, goggles, and or face shield at least every four hours. Relieving pressure for a few minutes to allow for normal blood flow can prevent lasting skin damage.

Healthcare workers across the country are fighting tirelessly against COVID-19. They're wearing head to toe PPE around the clock. They're hot and frustrated while wearing it, and… they also lose their identity. Patients just see masks, suits, gloves, and goggles. Hospital staff wants this to change.

"Share Your Smile" and the "Button Project" are just 2 examples of a small, but positive movement. To look less intimidating to patients, healthcare heroes are attaching large photos and buttons of their faces, to their PPE.  

The goal of these projects is to eliminate or reduce a level of fear and anxiety for patients, especially children, who find comfort in seeing the smiling faces of healthcare team members.

San Diego respiratory therapist Robertino Rodriguez started the "Share Your Smile" idea. Rodriguez said, “Yesterday I felt bad for my patients in ER when I would come in the room with my face covered in PPE. A reassuring smile makes a big difference to a scared patient. So today I made a giant laminated badge for my PPE so my patients can see a reassuring and comforting smile.”

The movement is catching on amongst health care workers. Peggy Ji, an ER Doctor in Los Angeles, wrote on Instagram, "I was inspired by Robertino Rodriguez who works as a respiratory therapist in this COVID pandemic. I didn’t have a preprinted photo or a color printer so my polaroid will have to do. I wanted to bring a personal touch to caring for patients through my PPE. My hope is that our patients will know there’s a reassuring smile under this mask, and that we’re here for them."

Nurse Derek also posted a photo of himself and fellow coworkers on Instagram saying, "thought it was a beautiful way to bring ease to our patients during this stressful time. Thank you to all the healthcare workers out there for battling on the frontlines."

The Button project holds the same meaning and started at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Adelaide Vienneau, Director of the Children’s Hospital Family Resource Center (FRC) said, “When we were asked to take the lead on this project, I immediately said, ‘yes.' The FRC team likes finding solutions for staff and providing resources to assist patients and families in having the best possible experience during their health care visit. We are delighted with the anecdotal comments on how the photo buttons have been well-received.”

Any time in the hospital as a patient is a scary time for the patient. The personal connection is so important, but difficult to achieve with all of the PPE. What a simple, yet creative way to put patients at ease to feel a more personal connection with the healthcare team.

What is your place of employment doing about this? Please share with our community. Thank you!

Researchers at MIT and Brigham and Women’s Hospital designed a new face mask that is believed to be as effective as N95 masks. 

There has been a dire need for N95 masks in hospitals across the nation. Essential workers were wearing the disposable masks more than once, often weeks at a time. 

Engineers and researchers hope to provide a solution to this shortage by designing a mask that can be safely reused. 

According to CNBC, the new MIT mask is made from silicone, with slots for just two small, disposable disks of the N95 material (which serve as filters). That means the masks themselves can be quickly and easily sterilized and reused.

Adam Wentworth, a Research Engineer at Brigham and Women’s Hospital said, "With this design, the filters can be popped in and then thrown away after use, and you’re throwing away a lot less material than an N95 mask." 

The mask is called iMASC, which stands for Injection Molded Autoclavable, Scalable, Conformable. The iMASC can be sterilized a couple of different ways. You can use a steam sterilize, put it in an oven, or soak them in both bleach and rubbing alcohol. 

In a study researchers had 20 healthcare workers wear the mask and perform a series of movements to see how it stayed in place. High ratings were given for fit and breathability. 

The study also showed the mask successfully filtered out a sugar solution in the air that was used to mimic aerosolized respiratory droplets.

According to FastCompany, researchers are beginning talks with the FDA about emergency use authorization, both for healthcare workers and the general public. The team is currently running both an environmental impact study and a cost-effectiveness study, and has estimated that its mask could cost just $15 and be used up to 100 times, making the cost per use likely less than a quarter, with the filter inserts less than a dollar.

There is no timeline yet as to when these masks will be available. 

Bonnie Castillo, is the Executive Director of National Nurses United (NNU) and a former Intensive Care Nurse. 

Back in January, Castillo was concerned by news reports about a virus that was devastating Wuhan, China. So she called for a meeting with the NNU's Director of health and safety and its industrial hygienist to go through scientific reports.

After learning more about the coronavirus, she directed her staff to investigate how prepared U.S. hospitals were for an outbreak.

According to the New York Times, Bonnie said, “As a Nurse, there are just times when it’s very intuitive. You just sense that something catastrophic is going to happen.”

The NNU contacted hundreds of hospitals asking for detailed information about how much personal protective equipment (PPE) they had. The union also surveyed thousands of Nurses asking how they felt about their health facilities’ readiness.

While the survey is ongoing, here are highlights as of March 3, 2020 tallying responses from more than 6,500 Nurses in 48 states, including the District of Columbia and the Virgin Islands.

Some highlights from the survey include:

• Only 44% report that their employer has provided them information about novel coronavirus and how to recognize and respond to possible cases.
• Only 29% report that there is a plan in place to isolate a patient with a possible novel coronavirus infection. 23% report they don't know if there is a plan.
• Only 63% of nurses report having access to N95 respirators on their units. 27% have access to PAPRs. 
• Only 30% report that their employer has sufficient PPE stock on hand to protect staff if there is a rapid surge in patients with possible coronavirus infections. 38% don't know.
• Only 65% report having been trained on safely donning and doffing PPE in the previous year.

At the beginning of March, Castillo’s team sent a letter to Vice President Mike Pence and the coronavirus task force coordinator Dr. Deborah Birx, warning that “the majority of U.S. health care facilities are completely unprepared to safely contain Covid-19.”

Then they asked the Occupational Safety and Health Administration (OSHA) to issue an “emergency temporary standard” for infectious diseases which would prompt employers to implement safety standards such as providing more effective N95 masks to Nurses working with coronavirus patients, instead of basic surgical masks. But OSHA didn't take Bonnie's advice.

The Centers for Disease Control and Prevention (CDC) then acknowledged that hospitals did lack sufficient PPE. So the CDC decided to loosen restrictions and required hospitals to provide their staff with only surgical masks, not N95 masks in many situations.

Castillo and her team were rightfully upset and decided to push publicly for more PPE. They held more than 350 socially distanced protests and 2 vigils in front of the White House for Nurses who died from COVID-19. 

"Nurses are not afraid to care for our patients if we have the right protections," Bonnie told NPR. "But we're not martyrs sacrificing our lives because our government and our employers didn't do their jobs."

After protests, some officials began allowing the N95 masks for all Nurses working with Covid-19 patients.

In May, House Democrats passed a stimulus bill that included some of the Nurses’ demands, including mass production of PPE through the Defense Production Act and an emergency temporary standard for infectious diseases.

Bonnie is still fighting for adequate PPE for Healthcare workers as the coronavirus rages on and concerns grow about a second wave of infections in the fall. She is an advocate and a cheerleader for all Nurses. It is imperative Nurses and all Healthcare workers get the PPE they need to protect themselves and their families, so they can provide care for their patients.