Subject(s)
COVID-19 , Dermatology , Telemedicine , Hospitals , Humans , Pandemics , Referral and ConsultationSubject(s)
COVID-19 , Exanthema , Skin Diseases, Viral , Hospitalization , Humans , SARS-CoV-2 , Tertiary Care CentersABSTRACT
Background: The World Health Organization recommends healthcare providers wear personal protective equipment (PPE) to prevent COVID-19 infection. There are no universally accepted recommendations for PPE usage by healthcare providers when caring for asymptomatic patients who can transmit infection. Objective: To survey PPE usage across medical dermatology practices and assess provider concern for COVID-19 transmission in the workplace. Methods: An anonymous survey was distributed via e-mail to dermatologists with membership in the Society for Dermatology Hospitalists and the Association of Professors in Dermatology. Questions pertained to use and perception of PPE in outpatient encounters. The survey remained open for 6 weeks and reached a predetermined target response number of 50-100 dermatologists among 429 recipients. Results: 88 dermatologists completed the survey (20.5%) and the majority practice in an outpatient clinic (80.7%). When caring for patients, most practices officially recommended utilizing a surgical mask (95.5%) and face shield (52.3%). Though a minority of practices recommended an N95 respirator (9.1%) or gloves (29.5%), a larger fraction of dermatologists self-reported using an N95 respirator (26.1%) and/or gloves (43.2%). 35.2% of dermatologists supplemented practice-provided PPE by providing personally obtained PPE, and 18.2% of dermatologists felt their institution did not adequately address their perceived risk of contracting COVID-19. 42.0% of physicians perceived their risk of contracting COVID-19 at work to be moderate or high. Conclusion: An appreciable fraction of dermatologists perceived their COVID-19 infection risk to be medium or high, and some dermatologists are taking supplemental safety measures. This study calls attention to the level of provider-perceived risk and highlights opportunities to address provider concerns regarding COVID-19 transmission.
ABSTRACT
Background: Cutaneous manifestations have been associated with COVID-19 infection and their clinical significance in hospitalized patients remains unclear. Methods: A retrospective chart review of 1216 patients older than 18 years of age hospitalized with laboratory-confirmed SARS-CoV-2 infection from March 12, 2020 to May 31, 2020 at a large urban academic medical center. A keyword search query of patient records combined with manual chart review by at least two dermatologists identified a study group having cutaneous manifestations concurrent with COVID-19 infection, specifically between 14 days prior to admission and up to discharge. Results: 122 patients with 195 skin lesions concurrent with COVID-19 hospitalization were identified. Dermatology reviewers evaluated clinical photographs for 116 lesions (59.5%) and inpatient dermatology consultations for 42 lesions (21.5%). The most common cutaneous findings in patients with COVID-19 hospitalization were pressure injuries (n=118;60.5%) and morbilliform eruptions (n=33;16.9%). A very small number of patients (0.6%;n=7/1216) had exanthems occurring within 2 weeks of COVID-19 symptom onset. The majority of exanthems developed within 14 days of exposure to possible culprit drugs and beyond the 14-day window of COVID-19 symptom onset, making viral association unlikely. Conclusion: Skin lesions concurrent with COVID-19 hospitalization were most frequently linked to hospitalization-related factors, such as pressure injuries or drug-related exanthems, rather than due to novel pathologies related to SARS-CoV-2 itself.