Craniofacial trauma: Experience in private hospital care during the pandemic provoked by SARS-CoV-2.

BACKGROUND: The onset of the SARS-Cov-2 pandemic brought with it important changes in the hospital care for all diseases. According to the international literature, since the beginning of the pandemic there has been an impact in the incidence, etiology, and severity of head trauma, all these changes as a direct consequence of lockdown. OBJECTIVE: In this article we analyzed the characteristics of craniofacial trauma in patients admitted to a private hospital in Mexico City during the SARS-CoV-2 pandemic. METHOD: Medical records from patients admitted in Medica Sur between March 2020 and June 2021. In this study, incidence, etiology, severity of the injuries and the SARS-CoV-2 PCR result performed upon admission were analyzed. RESULTS: Although there is no study in Mexico like ours, the results were similar to those reported by other hospital centers worldwide, presenting a greater number of cases classified as mild craniofacial trauma, in addition to finding that the main age group affected were older adults. CONCLUSIONS: The reported information in our study provides a general view of craniofacial trauma characteristics during SARS-CoV-2 pandemic.

INTRODUCCIÓN: El inicio de la pandemia provocada por SARS-CoV-2 trajo consigo importantes cambios en los cuidados hospitalarios para todas las enfermedades. De acuerdo con la literatura internacional, desde el comienzo, y a consecuencia del aislamiento, ha existido un impacto en la incidencia, la etiología y la gravedad del trauma craneomaxilofacial. OBJETIVO: Estudiar las características del trauma craneofacial en los pacientes ingresados a un hospital privado en la Ciudad de México durante la pandemia por SARS-CoV-2. MÉTODO: Se revisaron los expedientes clínicos de los pacientes ingresados a Médica Sur, entre marzo de 2020 y junio de 2021. Se analizaron la incidencia, la etiología, la gravedad de las lesiones y el resultado de la prueba de reacción en cadena de la polimerasa para SARS-CoV-2 que se realizó durante la atención hospitalaria. RESULTADOS: En México no existe un estudio semejante al nuestro, pero los resultados fueron similares a los reportados por otros centros hospitalarios en el mundo, presentando un mayor número de casos clasificados como traumatismo craneofacial leve, además de encontrar que el principal grupo de edad afectado fueron los adultos mayores. CONCLUSIONES: La información reportada en nuestro estudio brinda un panorama general sobre las características del trauma craneofacial durante la pandemia por SARS-CoV-2.

FFP3 Feelings and Clinical Experience (FaCE). Facial pressure injuries in healthcare workers from FFP3 masks during the COVID-19 pandemic.

AIMS: Prolonged wear of filtering facepiece 3 (FFP3) masks during the COVID-19 pandemic has led to dermatoses, including pressure sores. This study aimed to better understand the local scale and nature of the problem, coping strategies, and impact on those affected. METHODS: A survey was designed by plastic surgeons, tissue viability nurses, and critical care doctors. Key elements were demographics, mask-wearing behaviours, facial injuries, coping mechanisms, and impacts, such as time off work or redeployment. Question types were multiple-choice questions, visual analogue scales, and blank space. It was distributed for voluntary completion at a London NHS Trust via staff update emails and posters. RESULTS: Between 24th April-15th May 2020, 178 surveys were completed in full. Participants were 84% female, 55% worked in ITU, and 48% were nurses. Grade 1 facial pressure injuries were reported by 79% of respondents (n=124). Other significant occupational dermatoses included pain (70%), dry skin (50%), and acne (41%). The cheeks and bridge of nose were most affected. Staff used barrier creams (17%), dressings (17%), and analgesia (10%) to manage facial injuries. Half of those who modified their mask were not re-fit tested. A total of 33% required redeployment to a non-FFP3 area or time off. CONCLUSIONS: FFP3 masks worn beyond the recommended 1 h are associated with facial injuries. When advanced PPE (i.e., powered airflow masks) is unavailable, we must provide targeted skincare support (prevent and manage), modify shift patterns to reduce mask wear intensity, and amend fit test protocols to optimise protection against COVID-19.

Relationship between work-related ocular events, facial injuries and associated factors amongst dental professionals during COVID-19.

BACKGROUND: In dental settings, COVID-19 can be transmitted directly from patients to dentists through small droplets, saliva splashes, blood, and other body fluids liberated as a result of dental procedures. OBJECTIVE: To determine the prevalence of ocular and facial injuries in dental professionals and to investigate factors in dental practice contributing to ocular injuries. METHODS: An analytical cross-sectional study was performed in public and private sector universities. The study had 301 participants including final year undergraduate students, interns, postgraduate trainees, general practitioners, and dental specialists. Data were gathered online using Google forms. Information on sociodemographic, practice details, history of ocular and facial encounters during the clinical experience, and protective measures adopted by the dentists were collected. Means and standard deviations were calculated for continuous variables whereas frequencies and percentages were calculated for categorical variables. A Chi-square test was applied for association between variables. RESULTS: Ocular events and facial injuries occurred more in females 204 (67.8%) than in males 97(32.2%). Final year students reported more incidence of ocular encounters than specialists (40.9%, 3.3%). Dentists working in the government sector underwent more ocular encounters than those in private sectors 185(61.4%) and 96 (31.8%). Majority of participants reported that scaling was the procedure in which dentists experienced an ocular event. A significant association was found between ocular events, qualification, years of experience in clinical practice, number of patients treated per day, improper posture, and proper armamentarium (p < 0.05). However, no association was found between ocular events, gender, working sector, and dental procedures. CONCLUSION: Occurrence of ocular injuries were high compared to facial injuries and these outcomes were dependent on dental expertise and experiences. Appropriate measures should be adopted to minimize the risk of disease transmission and COVID-19 through the eyes among practicing dentists.

The Impact of COVID-19 on the Faces of Frontline Healthcare Workers.

As the coronavirus epidemic continues, a host of new cutaneous complications is seen on the faces of frontline healthcare workers wearing personal protective equipment on a daily basis. To minimize the risk of COVID-19 infection, healthcare workers wear tight-fitting masks that lead to an excessive amount of pressure on the facial skin. Mechanical pressure, mask materials, and perspiration can all lead to various types of cutaneous lesions such as indentations of the face, skin tears, post-inflammatory hyperpigmentation, ulceration, crusting, erythema, and infection. The objective of this article is to provide effective and straightforward recommendations to those health care providers using facial masks in order to prevent skin-related complications. J Drugs Dermatol. 2020;19(9):858-864. doi:10.36849/JDD.2020.5259.

Full-Thickness Facial Pressure Injury and Buried Dentition from Prone Positioning in a Patient with COVID-19.

ABSTRACT: Prone positioning is recognized for its efficacy in the treatment of acute respiratory distress syndrome related to COVID-19. Here the authors present a case of a facial pressure injury and buried dentition that occurred as a result of prolonged prone positioning in a patient who was COVID-19 positive. The patient was treated with primary closure of the injury and pressure offloading.

Association Between Skin Injuries in Medical Staff and Protective Masks Combined with Goggles During the COVID-19 Pandemic.

OBJECTIVE: To explore the relationship between wearing protective masks and goggles and skin injuries in medical staff during the COVID-19 pandemic. METHODS: Researchers conducted a cross-sectional, multicenter online survey. Respondents voluntarily completed the questionnaire on their smartphones. Ordinal and multinomial logistic regressions were used to identify factors related to skin injuries. RESULTS: In total, 1,611 respondents wore protective masks combined with goggles in 145 hospitals in China; 1,281 skin injuries were reported (overall prevalence, 79.5%). Multiple concomitant skin injuries (68.5%) and injuries in four anatomic locations (24.0%) were the most common, followed by injuries in three (22.8%), two (21.7%), and one location (11.0%). Multinomial logistic regression indicated that sweating increased the risk of injuries in one to four anatomic locations (95% confidence interval for odds ratio 16.23-60.02 for one location and 38.22-239.04 for four locations), and wearing an N95 mask combined with goggles and a daily use longer than 4 hours increased the risk of injuries in four locations (95% confidence interval for odds ratio 1.18-5.31 and 1.14-3.93, respectively). CONCLUSIONS: The prevalence of skin injuries among medical staff wearing protective masks combined with goggles was very high. These were mainly device-related pressure injuries, moisture-associated skin damage, and skin tears. The combination of various factors resulted in skin injuries at multiple sites. Preventing and managing sweating should be a focus for medical staff who wear protective masks combined with goggles for more than 4 hours.

Facial pressure injuries and the COVID-19 pandemic: skin protection care to enhance staff safety in an acute hospital setting.

OBJECTIVES: The aim of this study was to determine the impact of a specially designed care bundle on the development of facial pressure injuries (PI) among frontline healthcare workers wearing personal protective equipment (PPE) during the COVID-19 pandemic. The primary outcome of interest was the incidence of facial PIs. The secondary outcomes of interest were facial pain while wearing PPE and ease of use of the care bundle. METHODS: This study used a voluntary survey by questionnaire, supplemented by a qualitative analysis of interviews from a small purposive sample that took place in one large Irish hospital over a two-month period in 2020. The hospital was a city-based public university teaching hospital with 800 inpatient beds. The intervention was a care bundle consisting of skin protection, face mask selection, material use, skin inspection, cleansing and hydration developed in line with international best practice guidelines. All staff working in COVID-19 wards, intensive care units and the emergency department in the hospital were given a kitbag containing the elements of the care bundle plus an information pamphlet. Data were collected via a survey and interviews. RESULTS: A total of 114 staff provided feedback on the use of the care bundle. Before using the care bundle 29% (n=33) of the respondents reported developing a facial PI, whereas after using the care bundle only 8% (n=9) of the respondents reported developing a facial PI. The odds ratio (OR) of skin injury development was 4.75 (95% confidence interval (CI): 2.15-10.49; p=0.0001), suggesting that after the care bundle was issued, those who responded to the survey were almost five times less likely to develop a skin injury. Interviews with 14 staff determined that the bundle was easy to use and safe. CONCLUSION: Among those who responded to the survey, the use of the bundle was associated with a reduction in the incidence of skin injury from 29% to 8%, and respondents found the bundle easy to use, safe and effective. As with evidence from the international literature, this study has identified that when skincare is prioritised, and a systematic preventative care bundle approach is adopted, there are clear benefits for the individuals involved.

The Face of COVID-19: Facial Pressure Wounds Related to Prone Positioning in Patients Undergoing Ventilation in the Intensive Care Unit.

In the setting of COVID-19 (coronavirus disease 2019)-associated moderate and severe acute respiratory distress, persistently hypoxemic patients often require prone positioning for >16 hours. We report facial pressure wounds and ear necrosis as a consequence of prone positioning in patients undergoing ventilation in the intensive care unit in a tertiary medical center in New York City.

Effectiveness of using hydrocolloid dressing combined with 3M Cavilon No-Sting Barrier Film to prevent facial pressure injury on medical staff in a COVID-19 designated hospital in China: a self-controlled study.

BACKGROUND: COVID-19 is rapidly transmitted and has aroused enormous concern globally. This study aimed to investigate the effect of hydrocolloid dressing combined with 3M Cavilon No-Sting Barrier Film on the prevention of facial pressure injury in medical staff tasked with preventing and controlling COVID-19. METHODS: This was a self-controlled study. Medical staff who treated patients with COVID-19 infection in isolation wards from 6 January to 2 February, 2020, were selected to participate. Phase I was defined as the first 2 weeks of medical personnel entering the isolation ward, with phase II being the following 2 weeks. In phase I, medical workers only used hydrocolloid dressing on their faces, and in phase II, they used both hydrocolloid dressing and 3M Cavilon No-Sting Barrier Film. RESULTS: A total of 116 medical workers were selected as research subjects. The average facial local temperature in phase I was higher than that in phase II from the baseline (day 1) to the end of the study (day 14); however, there was no statistically significant difference (P>0.05). The incidence of facial pressure injury in phase II was lower than that in phase I (P<0.05); the facial skin comfort level among medical staff in phase II was higher than that in phase I (P<0.05). CONCLUSIONS: Hydrocolloid dressing combined with 3M Cavilon No-Sting Barrier Film for facial skin care can effectively reduce the incidence of facial pressure injury and can improve skin comfort level while ensuring isolation and a protective effect.

Severely injured patients do not disappear in a pandemic: Incidence and characteristics of severe injuries during COVID-19 lockdown in Finland.

Background and purpose - COVID-19 lockdowns have resulted in noteworthy changes in trauma admissions. We report and compare the incidence and characteristics of severe injuries (New Injury Severity Score [NISS] > 15) during the COVID-19 lockdown in Finland with earlier years.Methods - We retrospectively analyzed incidence rate, injury severity scores, injury patterns, and mechanisms of injury of all severely injured patients (NISS >15) in 4 Finnish hospitals (Tampere University Hospital, Kuopio University Hospital, Central Finland Hospital, Mikkeli Central Hospital) during the 11-week lockdown period (March 16-May 31, 2020) with comparison with a matching time period in earlier years (2016-2018). These 4 hospitals have a combined catchment area of 1,150,000 people or roughly one-fifth of the population of Finland.Results - The incidence rate of severe injuries during the lockdown period was 4.9/105 inhabitants (95% CI 3.7-6.4). The incidence rate of severe injuries during years 2016-2018 was 5.1/105 inhabitants (CI 3.9-6.5). We could not detect a significant incidence difference between the lockdown period and the 3 previous years (incidence rate difference -0.2 (CI -2.0 to 1.7). The proportion of traffic-related accidents was 55% during the lockdown period and 51% during previous years. There were no detectable differences in injury patterns. During the lockdown period, the mean age of patients was higher (53 years vs. 47 years, p = 0.03) and the rate of severely injured elderly patients (aged 70 or more) was higher (30% vs. 16%).Interpretation - Despite heavy social restrictions, the incidence of severe injuries during the lockdown period was similar to previous years. Notably, a decline in road use and traffic volumes did not reduce the number of severe traffic accidents. Although our data is compatible with a decrease of 2.0 to an increase of 1.7 severely injured patients per 105 inhabitants, we conclude that severely injured patients do not disappear even during pandemic and stabile hospital resources are needed to treat these patients.

Facial Pressure Injuries from Prone Positioning in the COVID-19 Era.

OBJECTIVE/HYPOTHESIS: This study aimed to determine the incidence of facial pressure injuries associated with prone positioning for COVID-19 patients as well as to characterize the location of injuries and treatments provided. METHODS: This was a retrospective chart review of 263 COVID-19 positive patients requiring intubation in the intensive care units at MedStar Georgetown University Hospital and MedStar Washington Hospital Center between March 1st and July 26th, 2020. Information regarding proning status, duration of proning, presence, or absence of facial pressure injuries and interventions were collected. Paired two-tailed t-test was used to evaluate differences between proned patients who developed pressure injuries with those who did not. RESULTS: Overall, 143 COVID-19 positive patients required proning while intubated with the average duration of proning being 5.15 days. Of those proned, 68 (47.6%) developed a facial pressure injury. The most common site involved was the cheek with a total of 57 (84%) followed by ears (50%). The average duration of proning for patients who developed a pressure injury was significantly longer when compared to those who did not develop pressure injuries (6.79 days vs. 3.64 days, P < .001). CONCLUSIONS: Facial pressure injuries occur with high incidence in patients with COVID-19 who undergo prone positioning. Longer duration of proning appears to confer greater risk for developing these pressure injuries. Hence, improved preventative measures and early interventions are needed. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2139-E2142, 2021.

The correlation analysis between the appearance anxiety and personality traits of the medical staff on nasal and facial pressure ulcers during the novel coronavirus disease 2019 outbreak.

Aim: To investigate the psychological status of medical staff with medical device-related nasal and facial pressure ulcers (MDR PUs) during the outbreak of COVID-19, analyse the correlation between their psychological status and personality traits, so as to provide a reference for personalized psychological support. Design: A total of 207 medical staff who were treating the COVID-19 epidemic from Hunan and Hubei provinces were enrolled in this analytic questionnaire-based study. Methods: We used these measures: Eysenck Personality Questionnaire Short Scale (EPQ-RSC), Social Appearance Anxiety Scale (SAAS), Positive and Negative Affect Scale (PANAS) and demographic information forms online. Results: Medical staff wearing protective equipment are particularly susceptible to nasal and facial MDR PUs, which is increasing their social appearance anxiety; neuroticism is significantly related to social appearance anxiety and negative emotion. We should pay more attention to their psychological state, cultivate good personality characteristics and reduce negative emotions, and thereby alleviate their MDR PUs-related appearance anxiety.

Preventing Facial Pressure Injury for Health Care Providers Adhering to COVID-19 Personal Protective Equipment Requirements.

OBJECTIVE: To determine if a repurposed silicone-based dressing used underneath an N95 mask is a safe and beneficial option for facial skin injury prevention without compromising the mask's seal. METHODS: Since February 21, 2020, staff in high-risk areas such as the ED and ICU of King Hamad University Hospital have worn N95 masks when performing aerosol-generating procedures to protect against the novel coronavirus 2019. At that time, without education enablers or resources that could be directly translated into practice, the hospital's Pressure Injury Prevention Committee explored, created, and tested a stepwise process to protect the skin under these masks while ensuring that it did not interfere with the effectiveness of the N95 mask seal. RESULTS: Skin protection was achieved by repurposing a readily available silicone border dressing cut into strips. This was tested on 10 volunteer staff members of various skin types and both sexes. Oxygen saturation values taken before and after the 4-hour wear test confirmed that well-fitted facial protection did not compromise the mask seal, but rather improved it. Staff also self-reported increased comfort with less friction. An educational enabler to prevent MDRPI from N95 mask wear was an important additional resource for the staff. CONCLUSIONS: This creative and novel stepwise process of developing a safe skin protection method enabling staff to apply a repurposed silicone border dressing beneath an N95 mask was largely effective and aided by the creation of the enabler.

The prevalence, characteristics, and related factors of pressure injury in medical staff wearing personal protective equipment against COVID-19 in China: A multicentre cross-sectional survey.

Since December 2019, the medical staff fighting against COVID-19 frequently reported the device-related pressure injury (DRPI) caused by personal protective equipment (PPE). We conducted a cross-sectional survey online to investigate the prevalence and characteristics of DRPI among medical staff. Univariate and multivariate logistic regression analyses were employed to explore the risk factors associated with DRPI. A total of 4308 participants were collected and 4306 participants were valid from 161 hospitals in China. The overall prevalence of DRPI caused by PPE among medical staff was 30.03% (95% CI 28.69%-31.41%). The prevalence of male was more than that of female (42.25%, 95% CI 37.99-46.51% vs 26.36%, 95% CI 26.93-29.80%, P < .001).The categories were mainly stages 1 and 2, and the common anatomical locations were nose bridge, cheeks, ears, and forehead. Logistic regression analysis revealed that the risk factors were sweating (OR = 43.99, 95% CI 34.46-56.17), male (OR = 1.50, 95% CI 1.12-1.99), level 3 PPE (OR = 1.44, 95% CI 1.14-1.83), and longer wearing time (OR = 1.28, 95% CI 0.97-1.68). The prevalence of DRPI was high among medical staff wearing PPE against COVID-19, and the risk factors were sweating, male, wearing level 3 PPE, and longer wearing time. Comprehensive preventive interventions should be taken.