Skin lesions associated with the use of N95 respirators among health professionals in Brazil in 2020

Gir, Elucir; Silva, Ana Cristina de Oliveira e; Caetano, Karlla Antonieta Amorim; Menegueti, Mayra Gonçalves; Brandão, Maria Girlane Sousa Albuquerque; Lam, Simon Ching; Reis, Renata Karina; Toffano, Silmara Elaine Malagutti; Pereira-Ávila, Fernanda Maria Vieira; Rabeh, Soraia Assad Nasbine

doi:10.1590/1518-8345.5937.3762

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 31 • 2023 • https://doi.org/10.1590/1518-8345.5937.3762 copy

Skin lesions associated with the use of N95 respirators among health professionals in Brazil in 2020 ^* * Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Grant # 401708/2020-9, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to investigate the prevalence of skin lesions and factors associated with the use of N95 respirators among health professionals in Brazil.

Method:

cross-sectional study conducted with 11,368 health professionals using a respondent-driven sampling method adapted for online environments. Univariate and multivariate analyses were performed to investigate the association between the “skin lesions with the use of N95 respirators” variable and gender, professional category, workplace, training, COVID-19 diagnosis, and availability of sufficient and high-quality Personal Protective Equipment.

Results:

the prevalence of skin lesions was 61.8%. Women were 1.203 times (95% CI: 1.154-1.255) more likely to develop a lesion than men. The chances of skin lesions in psychologists (PR=0.805; 95% CI: 0.678-0.956) and dentists (PR=0.884; 95% CI: 0.788-0.992), were lower when compared to Nursing professionals. Professionals with a positive COVID-19 diagnosis and working in the Intensive Care Unit have an increased chance of presenting skin lesions (PR=1.074; 95% CI: 1.042-1.107); (PR=1.203; 95% CI: 1.168-1.241), respectively.

Conclusion:

the prevalence of skin lesions caused by the use of N95 respirators was 61.8% and was associated with female gender, professional category, workplace, training, COVID-19 diagnosis, and availability of sufficient and highquality Personal Protective Equipment.

Descriptors:
Personal Protective Equipment; N95 Respirators; Skin; Health Personnel; Pandemics; Coronavirus

Variables	Skin lesion related to the use of N95 respirators		Total	p-value^* * p-value obtained from the chi-square test;	Prevalence Ratio	95% Confidence Interval
	Yes	No
	n	n
Gender
Male	1,254 (54.7)	1,039 (45.3)	2,293		Reference
Female	5,769 (63.6)	3,307 (36.4)	9,076	<0.01	1.162	(1.102;1.224)
Region
Northeast	2,245 (64.9)	1,214 (35.1)	3,459		Reference
North	1,015 (60.3)	669 (39.7)	1,684		0.929	(0.887;0.972)
Midwest	1,243 (61.7)	772 (38.3)	2,015	<0.01	0.950	(0.911;0.991)
Southeast	1,885 (58.4)	1,344 (41.6)	3,229		0.899	(0.865;0.934)
South	635 (64.7)	347 (35.3)	982		0.996	(0.917;1.018)
Professional Category
Nursing professionals	5,344 (61.9)	3,283 (38.1)	8,627		Reference
Physicians	816 (65.6)	428 (34.4)	1,244		1.059	(1.014;1.106)
Physiotherapists	439 (70.4)	185 (29.6)	624		1.136	(1.077;1.198)
Psychologists	59 (47.2)	66 (52.8)	125	<0.01	0.762	(0.632;0.918)
Speech Therapists	24 (55.8)	19 (44.2)	43		0.901	(0.690;1.716)
Occupational Therapists	18 (64.3)	10 (35.7)	28		1.038	(0.787;1.369)
Dentists	111 (48.3)	119 (51.7)	230		0.779	(0.681;0.891)
Other healthcare professionals	212 (47.3)	236 (52.7)	448		0.764	(0.692;0.843)
Worked in ICU^† † Intensive Care Unit;
No	4,956 (58.4)	3,527(41.6)	8,483	<0.01	Reference
Yes	2,067 (71.6)	819 (28.4)	2,886		1.226	(1.191;1.262)
Worked in a COVID-19 field hospital
No	4,627 (59.0)	3,212 (41.0)	10,310	<0.01	Reference
Yes	2,396 (67.9)	1,134 (32.1)	1,059		1.262	(1.226;1.299)
Infected by COVID-19
No	4,588 (59.8)	3,082 (40.2)	7,670	<0.01	Reference
Yes	2,435 (65.8)	1,264 (34.2)	3,699		1.100	(1.068;1.133)
Attended training or course on COVID-19
Yes	5,127 (63.3)	2,973 (36.7)	8,100	<0.01	Reference
Yes	1,896 (58.0)	1,373 (42.0)	3,269		0.916	(0.886;0.947)
The workplace provided sufficient PPE^‡ ‡ Personal Protection Equipment
Yes	4,937 (59.4)	3,376 (40.6)	8,313		Reference
No	374 (65.8)	194 (34.2)	568		1.109	(1.049;1.171)
Somehow	1,712 (68.8)	776 (31.2)	2,488	<0.01	1.159	(1.122;1.196)
The workplace provided good quality PPE^‡ ‡ Personal Protection Equipment
Yes	3,537 (56.6)	2,708 (43.4)	6,245		Reference
No	797 (68.7)	363 (31.3)	1,160	<0.01	1.213	(1.160;1.268)
Somehow	2,689 (67.8)	1,275 (32.2)	3,964		1.198	(1.162;1.235)

Variables	Have you had any skin changes related to the use of an N95 respirator?
	Yes	No
	n (%)	n (%)
Type
Hyperemia	4,243 (60.4)	2,780 (39.6)
Itching	2,086 (29.7)	4,937 (70.3)
Dryness	2,515 (35.8)	4,508 (64.2)
Broken Skin	2,342 (33.3)	4,681 (66.7)
Blisters/Bubbles	613 (8.7)	6,410 (91.3)
Not applicable	171 (2.4)	6,852 (97.6)
Site of the injury
Nose	5,192 (73.9)	1,831 (26.1)
Cheek	4,180 (59.5)	2,843 (40.5)
Ear	1,719 (24.5)	5,304 (75.5)
Chin	1,500 (21.4)	5,523 (78.6)
None	67 (1.0)	6,956 (99.0)

Variables	p-value^* * Chi-square Test;	Adjusted Prevalence Ratio	Confidence Interval (95%) for Prevalence Ratio
Male (Reference)
Female	<0.001	1.203	1.154	1.255
Northeast region (Reference)
North region	<0.001	0.924	0.879	0.970
Midwest region	0.02	0.949	0.908	0.992
Southeast region	<0.001	0.916	0.881	0.953
South region	0.49	1.019	0.966	1.076
Nursing Professionals (Reference)
Physicians	<0.001	1.111	1.069	1.161
Physiotherapists	0.02	1.082	1.019	1.148
Psychologists	0.004	0.805	0.678	0.956
Speech Therapists	0.38	0.897	0.692	1.162
Occupational Therapists	0.68	1.060	0.817	1.376
Dentists	0.02	0.884	0.788	0.992
Other	<0.001	0.837	0.766	0.914
Working in the ICU† (No) (Reference)
Working in the ICU^† † Intensive Care Unit; (Yes)	<0.001	1.20	1.168	1.241
Working in a field hospital (Yes) (reference)
Working in a field hospital (No)	<0.001	0.889	0.863	0.916
COVID-19 Diagnosis (No) (Reference)
COVID-19 Diagnosis (Yes)	<0.001	1.074	1.042	1.107
Received training (No) (Reference)
Received training (Yes)	<0.001	1.104	1.068	1.142
Insufficient PPE^‡ ‡ Individual Protection Equipment provided by the workplace (reference)
Sufficient PPE^‡ ‡ Individual Protection Equipment provided by the workplace	0.64	0.982	0.909	1.060
Somewhat sufficient PPE^‡ ‡ Individual Protection Equipment provided by the workplace	<0.001	1.071	0.993	1.155
Poor quality PPE^‡ ‡ Individual Protection Equipment provided by the workplace (reference)
Good quality PPE^‡ ‡ Individual Protection Equipment provided by the workplace	<0.001	0.810	0.765	0.854
Somewhat good quality PPE^‡ ‡ Individual Protection Equipment provided by the workplace	<0.001	0.942	0.888	1.000

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author:
Elucir Gir E-mail: egir@eerp.usp.br https://orcid.org/0000-0002-3757-4900

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Skin lesions associated with the use of N95 respirators among health professionals in Brazil in 2020 * * Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Grant # 401708/2020-9, Brazil.

Objective:

Method:

Results:

Conclusion:

Skin lesions associated with the use of N95 respirators among health professionals in Brazil in 2020 ^* * Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Grant # 401708/2020-9, Brazil.