Biophysical and biochemical changes in skin health of healthcare professionals using respirators during COVID‐19 pandemic
Biophysical and biochemical changes in skin health of healthcare professionals using respirators during COVID‐19 pandemic
Background: personal protective equipment, including respirator devices, has been used to protect healthcare workers (HCWs) during the COVID-19 pandemic. These are fitted to skin sites on the face to prevent airborne transmission but have resulted in reports of discomfort and adverse skin reactions from their continued usage. The present study addresses the objective changes in both the structural integrity and biological response of the skin following prolonged and consecutive use of respirators.
Materials and methods: a longitudinal cohort study, involving 17 HCWs who wear respirators daily, was designed. Changes in the barrier properties and biological response of the skin were assessed at three facial anatomical sites, namely, the nasal bridge, left cheek and at a location outside the perimeter of respirator. Assessments were made on three different sessions corresponding to the first, second and third consecutive days of mask usage. Skin parameters included transepidermal water loss (TEWL), stratum corneum (SC) hydration and erythema, as well as cytokine biomarkers sampled from sebum using a commercial tape.
Results: the cheek and the site outside the perimeter covered by the respirator presented minimal changes in skin parameters. By contrast, significant increases in both the TEWL (up to 4.8 fold) and SC hydration (up to 2.7 fold) were detected at the nasal bridge on the second consecutive day of respirator-wearing. There was a high degree of variation in the individual expression of pro-and anti-inflammatory cytokines. Increasing trends in nasal bridge TEWL values were associated with the body mass index (p < 0.05).
Conclusions: the most sensitive objective parameter in detecting changes in the skin barrier proved to be the increase in TEWL at the nasal bridge, particularly on the second day of consecutive respirator usage. By contrast, other measures of skin were less able to detect remarkable variations in the barrier integrity. Consideration for protecting skin health is required for frontline workers, who continue to wear respirators for prolonged periods over consecutive days during the pandemic.
COVID-19, inflammatory biomarkers, personal protective equipment (PPE), respirator protective equipment (RPE), skin health
Abiakam, Nkemjika
26818cc2-758e-4fa2-b1c3-8fef0ae82c4a
Jayabal, Hemalatha
8f2b053c-b614-4af2-b332-8ee861ab75f6
Mitchell, Kay
f57f07cd-0e3a-48b2-a871-c436eec325ae
Bader, Dan
9884d4f6-2607-4d48-bf0c-62bdcc0d1dbf
Worsley, Peter
6d33aee3-ef43-468d-aef6-86d190de6756
16 November 2022
Abiakam, Nkemjika
26818cc2-758e-4fa2-b1c3-8fef0ae82c4a
Jayabal, Hemalatha
8f2b053c-b614-4af2-b332-8ee861ab75f6
Mitchell, Kay
f57f07cd-0e3a-48b2-a871-c436eec325ae
Bader, Dan
9884d4f6-2607-4d48-bf0c-62bdcc0d1dbf
Worsley, Peter
6d33aee3-ef43-468d-aef6-86d190de6756
Abiakam, Nkemjika, Jayabal, Hemalatha, Mitchell, Kay, Bader, Dan and Worsley, Peter
(2022)
Biophysical and biochemical changes in skin health of healthcare professionals using respirators during COVID‐19 pandemic.
Skin Research and Technology.
(doi:10.1111/srt.13239).
Abstract
Background: personal protective equipment, including respirator devices, has been used to protect healthcare workers (HCWs) during the COVID-19 pandemic. These are fitted to skin sites on the face to prevent airborne transmission but have resulted in reports of discomfort and adverse skin reactions from their continued usage. The present study addresses the objective changes in both the structural integrity and biological response of the skin following prolonged and consecutive use of respirators.
Materials and methods: a longitudinal cohort study, involving 17 HCWs who wear respirators daily, was designed. Changes in the barrier properties and biological response of the skin were assessed at three facial anatomical sites, namely, the nasal bridge, left cheek and at a location outside the perimeter of respirator. Assessments were made on three different sessions corresponding to the first, second and third consecutive days of mask usage. Skin parameters included transepidermal water loss (TEWL), stratum corneum (SC) hydration and erythema, as well as cytokine biomarkers sampled from sebum using a commercial tape.
Results: the cheek and the site outside the perimeter covered by the respirator presented minimal changes in skin parameters. By contrast, significant increases in both the TEWL (up to 4.8 fold) and SC hydration (up to 2.7 fold) were detected at the nasal bridge on the second consecutive day of respirator-wearing. There was a high degree of variation in the individual expression of pro-and anti-inflammatory cytokines. Increasing trends in nasal bridge TEWL values were associated with the body mass index (p < 0.05).
Conclusions: the most sensitive objective parameter in detecting changes in the skin barrier proved to be the increase in TEWL at the nasal bridge, particularly on the second day of consecutive respirator usage. By contrast, other measures of skin were less able to detect remarkable variations in the barrier integrity. Consideration for protecting skin health is required for frontline workers, who continue to wear respirators for prolonged periods over consecutive days during the pandemic.
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Skin Research and Technology - 2022 - Abiakam - Biophysical and biochemical changes in skin health of healthcare
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Accepted/In Press date: 29 October 2022
Published date: 16 November 2022
Additional Information:
Funding Information:
The authors wish to thank all the healthcare professionals who engaged with the study for their commitment even in these unprecedented times. This work was supported by the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska‐Curie grant agreement number: 811965 (Project STINTS ‐ Skin Tissue Integrity under Shear). The work is also covered within the EPSRC funded project BE‐SAFE RPE (EP/V045563/1). Kay Mitchell is a National Institute for Health Research (NIHR) Senior Nurse and Midwife Research Leader. For the purpose of open access, the author has applied a CC BY public copyright licence to any author‐accepted manuscript version arising from this submission.
Publisher Copyright:
© 2022 The Authors. Skin Research and Technology published by John Wiley & Sons Ltd.
Keywords:
COVID-19, inflammatory biomarkers, personal protective equipment (PPE), respirator protective equipment (RPE), skin health
Identifiers
Local EPrints ID: 473135
URI: http://eprints.soton.ac.uk/id/eprint/473135
ISSN: 0909-752X
PURE UUID: f3921176-62eb-4ba2-bf24-1215bcdfe050
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Date deposited: 10 Jan 2023 18:32
Last modified: 17 Mar 2024 03:51
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Contributors
Author:
Nkemjika Abiakam
Author:
Hemalatha Jayabal
Author:
Kay Mitchell
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