SKIN INJURIES RELATED TO THE USE OF PERSONAL PROTECTIVE EQUIPMENT AMONG HEALTHCARE PROFESSIONALS DURING THE COVID‑19 PANDEMIC
DOI:
https://doi.org/10.66104/x4ddx668Keywords:
Injury; COVID 19; SkinAbstract
The COVID‑19 pandemic required the continuous use of Personal Protective Equipment (PPE) by healthcare professionals, an essential measure for infection prevention but associated with a significant increase in skin injuries, particularly pressure injuries (PI). In this context, understanding the magnitude and characteristics of these conditions became necessary. This study aimed to identify skin injuries related to PPE use among healthcare professionals during the COVID‑19 pandemic. An integrative review was conducted in the PubMed and LILACS databases, using controlled descriptors and inclusion criteria referring to the years 2020 and 2021. After screening and eligibility assessment, 20 studies composed the final sample. The results showed a high prevalence of skin injuries among frontline professionals, especially facial PI, dermatitis, irritation, maceration, and mechanical acne. N95 respirators, surgical masks, protective goggles, and impermeable gowns were the PPE most frequently associated with these injuries. The main risk factors included use for more than four hours, intense sweating, use of level‑3 PPE, inadequate fit, male sex, and age over 35 years. The most affected regions were the nasal bridge, cheeks, forehead, auricular area, and chin. The discussion highlights that the combination of mechanical pressure, friction, shear, and moisture constitutes the primary mechanism for the development of these injuries. Beyond physical impacts, skin damage affected psychological well‑being, professional performance, and increased contamination risk due to frequent facial touching. Preventive strategies such as protective barriers, scheduled pressure‑relief breaks, proper PPE fitting, and the development of more ergonomic technologies proved essential. It is concluded that skin injuries related to PPE use represent a significant occupational health issue during the COVID‑19 pandemic, requiring institutional actions focused on prevention, education, and preservation of skin integrity among healthcare workers. Protecting these professionals must include not only measures against viral infection but also strategies to minimize the adverse effects of the protective equipment itself.
Downloads
References
BARDIN, L. Análise de conteúdo. Lisboa: Edições 70, 2011.
BRAUN, V.; CLARKE, V. Using thematic analysis in psychology. Qualitative Research in Psychology, v. 3, n. 2, p. 77 101, 2006. DOI: 10.1191/1478088706qp063oa. Acesso em: 11 nov. 2025. DOI: https://doi.org/10.1191/1478088706qp063oa
COELHO, M. M. F. et al. Lesão por pressão relacionada ao uso de equipamentos de proteção individual na pandemia da COVID 19. Revista Brasileira de Enfermagem, Fortaleza, v. 73, n. 2, p. 1 7, 5 set. 2020. Disponível em: https://www.scielo.br/j/reben/a/xsSfYGGC6FvP6ChL8qxfWwc/. Acesso em: 11 nov. 2025.
DARLENSKI, R.; KAZANDJIEVA, J.; TSANKOV, N. Prevention and occupational hazards for the skin during COVID 19 pandemic. Clinics in Dermatology, v. 39, n. 1, p. 92 97, jun. 2021. DOI: 10.1016/j.clindermatol.2020.12.024. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33972059/. Acesso em: 5 nov. 2025. DOI: https://doi.org/10.1016/j.clindermatol.2020.12.017
DUAN, X. et al. Personal Protective Equipment in COVID 19. Journal of Occupational & Environmental Medicine, v. 63, n. 3, p. 221 225, 23 dez. 2020. DOI: 10.1097/JOM.0000000000002090. Acesso em: 11 nov. 2025. DOI: https://doi.org/10.1097/JOM.0000000000002123
GASPARINO, R. C. et al. Prophylactic dressings in the prevention of pressure ulcer related to the use of personal protective equipment by health professionals facing the COVID 19 pandemic: a randomized clinical trial. Wound Repair and Regeneration, v. 29, n. 1, p. 183 188, 28 nov. 2020. DOI: 10.1111/wrr.12877. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33215768/. Acesso em: 11 nov. 2025. DOI: https://doi.org/10.1111/wrr.12877
GEFEN, A.; OUSEY, K. Update to device related pressure ulcers: secure prevention, COVID 19, face masks and skin damage. Journal of Wound Care, v. 29, n. 5, p. 245 259, 2020. DOI: 10.12968/jowc.2020.29.5.245. Disponível em: https://pure.hud.ac.uk/en/publications/update-to-device-related-pressure-ulcers-secure-prevention-covid-/. Acesso em: 5 nov. 2025. DOI: https://doi.org/10.12968/jowc.2020.29.5.245
GEFEN, A.; OUSEY, K. Prevention of skin damage caused by the protective equipment used to mitigate COVID 19. Journal of Wound Care, v. 29, n. 6, p. 311 311, 2020. DOI: 10.12968/jowc.2020.29.6.311. Disponível em: https://www.magonlinelibrary.com/doi/abs/10.12968/jowc.2020.29.6.311. Acesso em: 5 nov. 2025. DOI: https://doi.org/10.12968/jowc.2020.29.6.311
GANONG, L. H. Integrative reviews of nursing research. Research in Nursing & Health, v. 10, n. 1, p. 1 11, 1987. DOI: 10.1002/nur.4770100103. Acesso em: 11 nov. 2025. DOI: https://doi.org/10.1002/nur.4770100103
JIANG, Q. et al. 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. International Wound Journal, v. 17, n. 5, p. 1300 1309, 2020. DOI: 10.1111/iwj.13391. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32396265/. Acesso em: 5 nov. 2025. DOI: https://doi.org/10.1111/iwj.13391
JIANG, Q. et al. The prevalence, characteristics, and prevention status of skin injury caused by personal protective equipment among medical staff in fighting COVID 19: a multicenter, cross sectional study. Advances in Wound Care, v. 9, n. 7, p. 357 364, 2020. DOI: 10.1089/wound.2020.1212. Disponível em: https://www.liebertpub.com/doi/abs/10.1089/wound.2020.1212. Acesso em: 11 nov. 2025. DOI: https://doi.org/10.1089/wound.2020.1212
LAN, J. et al. Skin damage among health care workers managing coronavirus disease 2019. Journal of the American Academy of Dermatology, v. 82, n. 5, p. 1215 1216, 2020. DOI: 10.1016/j.jaad.2020.03.014. Acesso em: 11 nov. 2025. DOI: https://doi.org/10.1016/j.jaad.2020.03.014
LONG, H. et al. Protecting medical staff from skin injury/disease caused by personal protective equipment during epidemic period of COVID 19: experience from China. Journal of the European Academy of Dermatology and Venereology, v. 34, n. 5, p. 919 921, 2020. DOI: 10.1111/jdv.16509. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32441424/. Acesso em: 5 nov. 2025. DOI: https://doi.org/10.1111/jdv.16388
MARRAHA, F. et al. Skin reactions to personal protective equipment among first line COVID 19 healthcare workers: a survey in northern Morocco. Dermatologic Therapy, v. 34, n. 1, p. e14794, 2021. DOI: 10.1111/dth.14794. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33876214/. Acesso em: 11 nov. 2025.
MASEN, M. A. et al. Evaluating lubricant performance to reduce COVID 19 PPE related skin injury. PLOS ONE, v. 15, n. 9, p. 1 13, 2020. DOI: 10.1371/journal.pone.0239363. Disponível em: https://europepmc.org/article/pmc/7514078. Acesso em: 11 nov. 2025. DOI: https://doi.org/10.2139/ssrn.3642575
MOORE, Z. et al. Facial pressure injuries and the COVID 19 pandemic: skin protection care to enhance staff safety in an acute hospital setting. Journal of Wound Care, v. 30, n. 3, p. 162 170, 2021. DOI: 10.12968/jowc.2021.30.3.162. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33729846/. Acesso em: 5 nov. 2025. DOI: https://doi.org/10.12968/jowc.2021.30.3.162
SALOMÉ, G. M.; DUTRA, R. A. A. Prevenção de lesões faciais causadas pelos equipamentos de proteção individual durante a pandemia da COVID 19. Revista Brasileira de Enfermagem, v. 74, n. 1, p. 1 7, 2021. DOI: 10.1590/0034 7167 2020 0615. Disponível em: https://www.scielo.br/j/reben/a/XbQRtTWW9QYZ8SXGyPrDr9F/. Acesso em: 5 nov. 2025.
YAN, Y. et al. Consensus of Chinese experts on protection of skin and mucous membrane barrier for health care workers fighting against COVID 19. Dermatologic Therapy, v. 33, n. 4, p. e13310, 2020. DOI: 10.1111/dth.13310. Disponível em: https://onlinelibrary.wiley.com/doi/abs/10.1111/dth.13310. Acesso em: 5 nov. 2025. DOI: https://doi.org/10.1111/dth.13310
YILDIZ, A. et al. Determination of the effect of prophylactic dressing on the prevention of skin injuries associated with personal protective equipment in health care workers during COVID 19 pandemic. Journal of Tissue Viability, v. 30, n. 1, p. 21 27, 2021. DOI: 10.1016/j.jtv.2020.10.006. Disponível em: https://www.sciencedirect.com/science/article/pii/S0965206X2030125X. Acesso em: 11 nov. 2025. DOI: https://doi.org/10.1016/j.jtv.2020.10.005
YU, J. N. et al. COVID 19 related pressure injuries in patients and personnel: a systematic review. Journal of Tissue Viability, v. 30, n. 1, p. 283 290, 2021. DOI: 10.1016/j.jtv.2021.03.004. Disponível em: https://www.sciencedirect.com/science/article/pii/S0965206X21000401. Acesso em: 11 nov. 2025. DOI: https://doi.org/10.1016/j.jtv.2021.04.002
YUAN, X. et al. Online survey on healthcare skin reactions for wearing medical grade protective equipment against COVID 19 in Hubei Province, China. PLOS ONE, v. 16, n. 4, p. 1 9, 2021. DOI: 10.1371/journal.pone.0250838. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33914813/. Acesso em: 11 nov. 2025. DOI: https://doi.org/10.1371/journal.pone.0250869
ZHANG, S. et al. 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. Annals of Palliative Medicine, v. 10, n. 1, p. 3 9, 2021. DOI: 10.21037/apm 20 1387. Disponível em: https://apm.amegroups.org/article/view/60707/html. Acesso em: 5 nov. 2025. DOI: https://doi.org/10.21037/apm-20-1615
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Ana Gabriela do Carmo Modolon, Karina Cardoso Gulbis, Valdemira Santina Dagostin, Luciane Bisognin Ceretta, Diogo Dominguine, Liliana Maria Dimer, Neiva Junkes Hoepers, Mágada Tessmann
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms:
Authors retain copyright and grant the journal the right of first publication, with the work simultaneously licensed under the Creative Commons Attribution License, which permits the sharing of the work with proper acknowledgment of authorship and initial publication in this journal;
Authors are authorized to enter into separate, additional agreements for the non-exclusive distribution of the version of the work published in this journal (e.g., posting in an institutional repository or publishing it as a book chapter), provided that authorship and initial publication in this journal are properly acknowledged, and that the work is adapted to the template of the respective repository;
Authors are permitted and encouraged to post and distribute their work online (e.g., in institutional repositories or on their personal websites) at any point before or during the editorial process, as this may lead to productive exchanges and increase the impact and citation of the published work (see The Effect of Open Access);
Authors are responsible for correctly providing their personal information, including name, keywords, abstracts, and other relevant data, thereby defining how they wish to be cited. The journal’s editorial board is not responsible for any errors or inconsistencies in these records.
PRIVACY POLICY
The names and email addresses provided to this journal will be used exclusively for the purposes of this publication and will not be made available for any other purpose or to third parties.
Note: All content of the work is the sole responsibility of the author and the advisor.
