School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin.
Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.
J Wound Care. 2021 Mar 2;30(3):162-170. doi: 10.12968/jowc.2021.30.3.162.
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.
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.
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.
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.
本研究旨在确定专门设计的护理包对在 COVID-19 大流行期间佩戴个人防护装备（PPE）的一线医护人员面部压力性损伤（PI）发展的影响。主要研究结果是面部 PI 的发生率。次要研究结果为佩戴 PPE 时的面部疼痛和护理包的易用性。
本研究采用问卷调查的自愿方式，并对 2020 年两个月内在一家大型爱尔兰医院进行的小范围、有针对性的访谈进行了定性分析。该医院是一家位于城市的公立大学教学医院，拥有 800 张住院病床。干预措施是一个护理包，包括皮肤保护、口罩选择、材料使用、皮肤检查、清洁和保湿，这是根据国际最佳实践指南制定的。所有在医院 COVID-19 病房、重症监护病房和急诊科工作的员工都收到了一个工具包，其中包含护理包的各个元素以及一本信息手册。数据通过调查和访谈收集。
共有 114 名员工对护理包的使用情况提供了反馈。在使用护理包之前，29%（n=33）的受访者报告出现面部 PI，而在使用护理包后，只有 8%（n=9）的受访者报告出现面部 PI。皮肤损伤发展的优势比（OR）为 4.75（95%置信区间（CI）：2.15-10.49；p=0.0001），这表明在发放护理包后，对调查做出回应的人发生皮肤损伤的可能性几乎降低了五倍。对 14 名员工的访谈确定，该包易于使用且安全。
在对调查做出回应的员工中，使用该包可将皮肤损伤的发生率从 29%降低至 8%，并且受访者发现该包易于使用、安全且有效。与国际文献中的证据一样，本研究表明，当优先考虑皮肤护理并采用系统的预防护理包方法时，相关人员会获得明显的益处。
