SKIN HEALTH MAY 08

Wearing a face mask all day may protect you, but what about your skin?

Simple strategies for avoiding skin abrasions and injuries from PPE

It’s perfectly clear that facemasks, especially N-95 respirators, are one of the most important tools for healthcare workers in the fight against COVID-19. Those of us at home or in non-healthcare settings are asked to wear cloth masks for protection and leave the surgical and respirator masks for those who truly need them. And of those of you who do need them— doctors, nurses, and other workers in contact with sick patients—you’re finding yourself wearing facemasks for hours without removing them, and then forced to put those same masks on over and over again. This is causing yet another problem: what you’re wearing to protect yourself could be damaging your skin.

Protection has its pitfalls

Here are the facts: when wearing PPE for long periods of time, people begin to sweat underneath their masks, increasing frictional force on the skin. This can lead to pressure injuries on the nose and cheeks.1 In addition, although masks are certainly not heavy, pressure is created on a small area of the skin near the mask’s edge. When an N-95 respirator is tightened around the face—which is essential to its success at forming the right seal around the nose and mouth—all the pressure is then concentrated onto the soft tissue, elevating the chance for injury. This is especially true on an area where bone is so close to the skin.2

The National Pressure Injury Advisory Panel (NPIAP) just published a position statement recommending the use of a liquid skin sealant or protectant to help prevent friction injury when wearing an N95 mask—underlining the value of protecting your skin from wearing PPE for long periods of time.3

A few simple steps before wearing PPE

Follow this simple routine to help increase your comfort and decrease your risk of skin injury while wearing PPE:

  1. Wash hands thoroughly and remove any makeup from cheeks and nose.
  2. Apply a skin protectant or barrier to the following areas: bridge of nose, cheekbones and behind ears*. Be careful to avoid contact near the eyes and allow to fully dry.
  3. Cut a low-profile foam dressing into thin strips and apply around the ears where your tie or band from the mask will hit. Trim as desired for comfort. If you have an earloop N95 mask specifically, place foam dressing strips directly behind the ears.
  4. Don the face mask and adjust for comfort.
  5. After mask removal, wash face and apply a moisturizer to your skin.
    Remember: always wash your hands before and after touching the mask.

5 smart ways to reduce moisture

In addition to following the steps when wearing PPE, it might be helpful to understand the various ways that protectants, moisturizers and dressings help reduce the excessive moisture or friction that can lead to Moisture Associated Skin Damage (MASD).

Here are a few suggested items to help maintain skin health:

Liquid skin protectants:

  • Can be used on the face to protect against abrasion, friction and shear
  • Bonds to skin to remain in place and naturally sloughs away to retain skin integrity
  • Helps protect skin from damage due to perspiration under surgical masks

No-sting skin protectants:

  • Transparent waterproof barrier on skin
  • Creates a film to protect from body fluids and adhesive stripping
  • Alcohol-free and formulated for delicate skin like the face
  • Fast drying and vapor permeable skin remains breathable

Moisturizing skin care:

  • Choosing a gentle moisturizer helps nourish skin
  • Helps reduce the appearance of red, cracked and scaly skin
  • Single-use packets provide a simple, safe way to moisturize and nourish caregivers’ skin

Thin foam dressings:

  • Protects ears (tops and backs) from abrasions due to masks
  • Easy to cut, very conformable, and low profile
  • Do not use under the face mask itself as this could potentially compromise the protective seal

Silicone adhesive dressing:

  • Has a gentle adhesive to minimize adhesive stripping and is transparent for easy view of the underlying skin
  • Features a water-resistant backing
  • Low-profile design increases flexibility and comfort

As part of a good practice protocol, the NPIAP has suggested that if you are able to remove your mask from your face for 15 minutes every two hours outside of areas of patient contact, you will at least reduce the duration of pressure. If this is not possible, try to at least lift the mask by the sides for five minutes every two hours.3 Your skin will thank you later.

Key takeaway

This content was created to help inform you and build on the position statement from the NPIAP and the WOCN Society. We want to help you protect yourself while protecting others. For more helpful resources, check out these skin health articles and guides:

  1. 5 smart ways to safeguard skin from PPE abrasions
  2. Protect your skin from a long day wearing PPE
  3. Protect your skin from long hours wearing an N95 mask

If you have questions on particular products or the right supplies to help reduce the likelihood of medical device related pressure injuries, contact your Medline Representative or call 1800 Medline. And if you would like to read additional skin health expertise and insights, visit medlineskinhealth.com.

* Please note: If using a prophylactic dressing or other skin protectant product under PPE, double-check to make sure that there is no interference with the efficacy of your PPE. Check out this guide to properly put on and take off a disposable respirator: https://www.cdc.gov/niosh/docs/2010-133/pdfs/2010-133.pdf

In addition, The National Pressure Injury Advisory Panel does not recommend the use of petroleum jelly, mineral oil or any other compound that could enhance slippage and affect the function of the N95 mask.