Even at the best of times, aged care workers face intense physical and emotional demands at work, but the pandemic has had a knack for magnifying the challenges.
One of the biggest issues aged care workers have faced in the time of COVID-19, one they have endured quietly day after day, is the requirement to wear personal protective equipment (PPE) – masks, gloves, shields and gowns – often for several hours a day, for months, or even years, at a time.
Wearing full PPE adds a layer of physical difficulty and stress for the already overburdened aged care workforce, and it can have serious consequences for their health, particularly their skin.
Recently, a member of HelloCare’s Aged Care Worker Support Group on Facebook wrote a post about the discomfort and effects on her skin from wearing full PPE at work.
Heather* posted an image on the support group of her inflamed and irritated skin, and redness under her eyes and across the bridge of her nose.
“I have been sweating like I have never sweated before.
“My back is covered in a rash, as well as my legs. My skin all over just feels so hot, really hot to touch and I just feel like I am burning. Any suggestions?” Heather put to the group.
“I am struggling big time.”
It seems that Heather was not alone in her discomfort. More than 100 members of the group responded, with several posting about their own irritated skin and injuries from wearing masks and PPE.
Many of the photos posted displayed even more severe conditions than Heather’s own problem.
“I felt really bad complaining about my issues when looking at some of the other girls’ problems,” she told HelloCare. “Mine was nothing compared to theirs.”
Many who commented on the post mentioned how hot they became wearing PPE, and how it caused them to perspire excessively, just as Heather had experienced. They said it was like working in a sauna.
One said she has been wearing full PPE for two years.
Those who commented shared dozens of remedies they had developed to help them cope – from Sudocream to aloe vera, from vitamin D cream to calamine lotion.
A few went so far as cutting off all their hair to help them cope with the heat. One used panty liners inside her bra to absorb moisture. Several said swimming in salt water was therapeutic.
Several mentioned the intense relief they felt when they were no longer required to wear PPE, and the anxiety they experienced about the possibility of having to return to wearing protective clothing.
Skin damage from PPE ‘very common’
A recent study of healthcare workers in Hubei, China, where COVID-19 was first identified, found that 69% experienced scarring across the bridge of their nose from wearing N95 masks and 28% experienced an itching face.
They found that 56% experienced dry skin from wearing latex gloves.
Wearing protective clothing caused 36% to experience dry skin and 34% to experience itching.
WoundCare Services director, Jan Rice, told HelloCare that it’s “very common” to develop skin problems from wearing PPE.
US nursing education website, Nurseslabs, has eight tips to help healthcare workers avoid skin damage from PPE.
1. Moisturise regularly
Wash your face and neck with soap and water after work. Pat your skin dry – rather than rub – and apply a light, good quality moisturiser.
Apply moisturiser before putting on PPE, but give it time to be absorbed into your skin. Ms Rice recommends at least half-an-hour, but before you leave for work is also a good time.
Dry your hands completely after washing them. Apply moisturiser before putting on your gloves. Wash and moisturise your hands immediately after removing your gloves.
2. Check your mask is fitted properly
Poorly fitted masks or masks not put on properly are a common cause of skin problems.
Put your mask on carefully and ensure it sits comfortably on your face and isn’t too tight or loose.
N95 masks should be individually fitted to your face – you should only wear an N95 mask that fits you.
Replace your mask as soon as it starts to feel really uncomfortable, or if it becomes wet or soiled.
3. Relieve pressure points as often as possible
Remove your mask, goggles or face shield at least once every four hours, and more often if possible.
According to Nurseslabs, even relieving the pressure for a few minutes will allow for more normal blood flow to the area and help prevent skin damage.
4. Use barrier cream
If you know you’re going to be wearing PPE for an extended period, you can apply a barrier cream. This is especially important if you already have some skin damage, such as bruising or an extended period of redness.
Barrier creams, such as dimethicone which contains silicon, are long lasting and seal off the skin from moisture and friction. You can apply to the parts of your face most affected by the PPE. Allow your skin to dry after applying, about a minute, before putting on your PPE.
5. When needed, apply dressings
Protective, moisture-absorbing dressings such as Comfeel can be used between your skin and areas on the PPE where there is pressure or friction. Dressings can be cut to fit different sections of the face to provide protection.
Your aged care home’s management can help you understand if this is necessary and which products to use.
You may need your mask refitted. Rice said some of the newer masks have foam built into them to prevent them from causing injuries.
6. Protect your ears
If you are attaching masks to caps or headbands, make sure you don’t pull the mask too tight and increase the pressure on your face. Surgical masks which tie behind the head appear to cause less irritation, so if available you could try this option.
7. Keep cool
‘Intertriginous dermatitis’ is a red, itchy rash that can be caused by wearing PPE gowns for extended periods. It is caused by moisture becoming trapped in the skin’s folds. To prevent this condition, dry carefully after showering and avoid tight clothing.
A barrier cream can be applied to the affected areas, but the skin can become infected, in which case you will need to see your doctor.
Wear moisture-absorbing underwear, and use talcum powder or corn starch to help keep the area dry.
8. Stay hydrated
Many of the aged care workers who responded to Heather’s post mentioned the importance of staying hydrated. Drink plenty of water during breaks, and before and after work.
Aged care workers are amazing
When HelloCare reached out to Heather to see how she is going now, she thankfully said she is doing better. Her rashes have cleared up and her skin is no longer irritated and causing her grief.
Heather was overwhelmed by the support shown to her on the support group, and the extent of so many other aged care worker’s suffering from wearing PPE.
She thanked them for all their suggestions.
“You are all amazing,” she said.
We agree.
*Name has been changed.
This article is not intended as medical advice.
Hi,
Really enjoyed reading this article, i too work in Aged Care and have had to wear PPE, I agree the profuse amount of sweating and exhaustion is so demanding. i would like to see Politicians wear PPE for a shift in Aged care or hospital, then review staffing levels and wages.
Kind regards,
Michael Preston