Personal protective equipment related skin reactions in healthcare professionals during COVID-19.

Since the outbreak of COVID-19 pandemic, clinicians have had to use personal protective equipment (PPE) for prolonged periods. This has been associated with detrimental effects, especially in relation to the skin health. The present study describes a comprehensive survey of healthcare workers (HCWs) to describe their experiences using PPE in managing COVID-19 patients, with a particular focus on adverse skin reactions. A 24-hour prevalence study and multi-centre prospective survey were designed to capture the impact of PPE on skin health of hospital staff. Questionnaires incorporated demographics of participants, PPE type, usage time, and removal frequency. Participants reported the nature and location of any corresponding adverse skin reactions. The prevalence study included all staff in intensive care from a single centre, while the prospective study used a convenience sample of staff from three acute care providers in the United Kingdom. A total of 108 staff were recruited into the prevalence study, while 307 HCWs from a variety of professional backgrounds and demographics participated in the prospective study. Various skin adverse reactions were reported for the prevalence study, with the bridge of the nose (69%) and ears (30%) being the most affected. Of the six adverse skin reactions recorded for the prospective study, the most common were redness blanching (33%), itchiness (22%), and pressure damage (12%). These occurred predominantly at the bridge of the nose and the ears. There were significant associations (P < .05) between the adverse skin reactions with both the average daily time of PPE usage and the frequency of PPE relief. The comprehensive study revealed that the use of PPE leads to an array of skin reactions at various facial locations of HCWs. Improvements in guidelines are required for PPE usage to protect skin health. In addition, modifications to PPE designs are required to accommodate a range of face shapes and appropriate materials to improve device safety.

An international consensus on device-related pressure ulcers: SECURE prevention.

Catherine Milne and colleagues present the findings of their review, ccna2@juno.com.

Preventing pressure injuries in the emergency department: Current evidence and practice considerations.

The emergency department (ED) is at the front line of hospital pressure injury (PI) prevention, yet ED clinicians must balance many competing clinical priorities in the care of seriously ill patients. This paper presents the current biomechanical and clinical evidence and management considerations to assist EDs to continue to develop and implement evidence-based PI prevention protocols for the high-risk emergency/trauma patient. The prevention of hospital-acquired pressure injuries has received significant focus internationally over many years because of the additional burden that these injuries place on the patient, the additional costs and impact to the efficiency of the hospital, and the potential for litigation. The development of a PI is the result of a complex number of biomechanical, physiological, and environmental interactions. Our understanding of the interaction of these factors has improved significantly over the past 10 years. We have demonstrated that large reductions in PI incidence rates can be achieved in critical care and general hospital wards through the application of advanced evidence-based prevention protocols and believe that further improvement can be achieved through the application of these approaches in the ED.

Estimating the costs associated with the management of patients with chronic wounds using linked routine data.

Chronic wounds are known to represent a significant burden to patients and National Health Service (NHS) alike. However, previous attempts to estimate the costs associated with the management of chronic wounds have been based on literature studies or broad estimates derived from incidence rates and extrapolations from relatively small-scale studies. The aim of this study is therefore to determine the extent of resource utilisation by patients classed as having chronic wounds within Wales using linked routine data - available through the Secure Anonymised Information Linkage (SAIL) database - to estimate the costs associated with the management of these patients by the NHS in Wales. The SAIL database brings together, and anonymously links, a wide range of person-based data from general practitioner (GP) practices within Wales, which includes primary and secondary care consultations to create an encrypted anonymised linking field for each individual. This linkage allows the patient pathway to be tracked through the NHS system both retrospectively and prospectively from a specific reference date. The estimated costs were derived by extrapolating to an all-Wales level from the results gleaned from the SAIL database using the respective READ codes to capture relevant patients with chronic wounds. The number of patients identified as having chronic wounds within the SAIL database was 78 090, which equates to 190 463 across Wales as a whole and a prevalence of 6% of the Welsh population. The total cost of managing patients with chronic wounds in Wales amounted to £328·8 million - an average cost of £1727 per patient and 5·5% of total expenditure on the health service in Wales. A relatively few READ codes represented a significant proportion of expenditure, with diabetic foot ulcers, leg ulcers, foot ulcers, varicose eczema, bed sores and postoperative wound care constituting 93% of total expenditure. When a more conservative perspective was used in relation to classification of chronic wounds, the total cost amounted to £303 million. However, these are likely to be underestimates because of the lack of information for patients with treatments lasting over 6 months and not including patients who might have entered the health care system of wound management elsewhere - such as patients contracting pressure ulcers in hospitals and having surgical wound infections.

Achieving consensus in pressure ulcer reporting.

Pressure ulcers are considered to be a key quality indicator and healthcare providers in England are required to report local pressure ulcer rates. However, there is a lack of standardisation in reporting due to lack of national guidance. The Tissue Viability Society has sought to develop consensus amongst all concerned parties on the most useful and robust methods of data collection. This document has been developed following a consensus meeting and consultation with the majority of Tissue Viability Nurses across England and provides guidance on reporting pressure ulcer rates. It is intended for use all organisations that are involved in the reporting of pressure ulcers. It represents the consensus view of a large number of Tissue Viability Nurses from across England and we recommend its adoption.

Pressure ulcers and incontinence-associated dermatitis: effectiveness of the Pressure Ulcer Classification education tool on classification by nurses.

CONTEXT: Previous studies report that pressure ulcer classification and differentiation from incontinence associated dermatitis are difficult. Incorrect classification and differentiation result in incorrect prevention and treatment. Education is important to spread evidence-based insights about this topic and to improve classification skills. AIM: To assess the effectiveness of the Pressure Ulcer Classification (PUCLAS) education tool. PUCLAS was developed by the PUCLAS Workgroup of the European Pressure Ulcer Advisory Panel. DESIGN: Randomised controlled trial. SETTING AND PARTICIPANTS: A convenience sample of 1217 Belgian, Dutch, British and Portuguese nurses. OUTCOME MEASURE: Correct classification of pressure ulcer photographs and differentiation from photographs of incontinence-associated dermatitis. RESULTS: Baseline, 44.5% of the photographs were classified correctly. In the post-test, the results in the intervention group were significantly higher (63.2%) compared with the control group (53.1%; p<0.001). The percentage of correct assessments of incontinence associated dermatitis (IAD) was 70.7% in the intervention group and 35.6% in the control group (p<0.001). The skill to differentiate IAD from pressure ulcers was significantly associated with the experimental intervention (OR 4.07, 95% CI 3.21 to 5.15, p<0.001). CONCLUSION: The PUCLAS tool improved pressure ulcer classification and IAD differentiation significantly.

Understanding the differences between moisture lesions and pressure ulcers.

This one-part unit discusses the difference between pressure ulcers and moisture lesions. It explores the causes of these skin problems and highlights the need for patient care plans to reflect the underlying cause of the problem.

EPUAP classification system for pressure ulcers: European reliability study.

AIM: This paper is a report of a study of the inter-observer reliability of the European Pressure Ulcer Advisory Panel pressure ulcer classification system and of the differential diagnosis between moisture lesions and pressure ulcers. BACKGROUND: Pressure ulcer classification is a valuable tool to provide a common description of ulcer severity for the purposes of clinical practice, audit and research. Despite everyday use of the European Pressure Ulcer Advisory Panel system, its reliability has been evaluated in only a limited number of studies. METHODS: A survey was carried out between September 2005 and February 2006 with a convenience sample of 1452 nurses from five European countries. Respondents classified 20 validated photographs as normal skin, blanchable erythema, pressure ulcers (four grades), moisture lesion or combined lesion. The nurses were familiar with the use of the European Pressure Ulcer Advisory Panel classification scale. RESULTS: Pressure ulcers were often classified erroneously (kappa = 0.33) and only a minority of nurses reached a substantial level of agreement. Grade 3 lesions were regularly classified as grade 2. Non-blanchable erythema was frequently assessed incorrectly as blanchable erythema. Furthermore, the differential diagnosis between moisture lesions and pressure ulcers appeared to be complicated. CONCLUSION: Inter-observer reliability of the European Pressure Ulcer Advisory Panel classification system was low. Evaluation thus needs to focus on both the clarity and complexity of the system. Definitions and unambiguous descriptions of pressure ulcer grades and the distinction between moisture lesions will probably enhance clarity. To simplify the current classification system, a reduction in the number of grades is suggested.

Wound assessment and the TIME framework.

A structured wound assessment is a crucial part of managing any patient with a wound. Many different wound assessment tools currently exist but there is little standardization in the information they are used to record. A simple framework such as TIME can be used to co-ordinate the data collection into more useful elements which assist in planning cost-effective care. Clustering the information under the key headings of TIME encourages the practitioner to relate what they are seeing to what is happening at a cellular level and manage wounds in a proactive rather than reactive manner, setting clear management/care objectives to facilitate the wound to heal where this is appropriate.

Choosing an appropriate antibacterial dressing.

There have been significant developments in the dressings available to treat infected wounds; this increased choice can, however, be confusing. Jacqui Fletcher outlines the key considerations for using an antimicrobial dressing and describes the key dressing groups that can be used to treat wound infection.

Full nursing assessment of patients at risk of diabetic foot ulcers.

A common complication of diabetes is the occurrence of foot ulcers. Good foot care can, in many instances, prevent ulcers or increase the potential to heal in those patients who do ulcerate. All healthcare professionals working with patients with diabetes should reinforce the importance of caring for the feet each time they see the patient. A focus on foot care reiterates to the patient the importance of self care and prevention of ulceration. Examination of the feet and timely referral to appropriate specialist teams are of particular importance.