Pressure Injuries Due to Personal Protective Equipment in COVID-19 Critical Care Units.

BACKGROUND: Caring for patients with COVID-19 requires wearing a full set of personal protective equipment (PPE) to avoid contamination. Personal discomfort has been associated with use of PPE, and anecdotal reports describe pressure injuries related to wearing PPE. OBJECTIVES: To investigate the occurrence of device-related pressure injuries due to wearing PPE among Italian nurses caring for patients with COVID-19 in critical care settings. METHODS: This descriptive study used an online survey investigating both the demographic characteristics of respondents and complications related to wearing PPE, including the development of pressure injuries. RESULTS: A total of 266 nurses throughout Italy completed the survey; 32% of respondents were men. Nurses' median age was 36 years (range 22-59 years), and the median time spent working in their current clinical setting (an intensive care or high-dependency unit) was 3 years (range 0-32 years). Personal protective equipment was worn for a median duration of 5 hours (range 2-12 hours). While wearing PPE, 92.8% of nurses experienced pain and 77.1% developed device-related pressure injuries, mainly on the nose, ears, and forehead. Pain was more frequent among nurses with such injuries. Transparent dressings, emollient cream, and no dressing were associated with development of device-related pressure injury. CONCLUSIONS: Pressure injuries related to PPE represent an important adverse effect for nurses caring for patients with COVID-19. This topic deserves study to determine adequate solutions for preventing and treating such injuries and their potential influence on nurses' work tolerance.

[The comfort of patients ventilated with the Helmet Bundle]. / The Helmet Bundle: il comfort del paziente ventilato con CPAP con scafandro.

INTRODUCTION: Interventions aimed at increasing comfort of patients treated with Helmet Continuous Positive Airway Pressure (H-CPAP) increase its endurance and the duration of treatment. AIM: To assess the effect of nursing interventions on factors of discomfort for H-CPAP patients. METHODS: The fixing method of the helmet (5 subjects), the noise generated by the gas source and the level of humidity in the helmet were assessed. Fixing method: pain measured with Numeric rating scales (NRS) and Stress detector after the application of armpit straps or counterweights. Noise: level of noise (decibel measurement) in the helmet and the interventions to reduce it. Humidity: level of humidity with different models of active humidifiers. RESULTS: The armpit straps increase the pain measured with the stress detector of 0.206 microSiemens and of 4.8 points of the NRS after 5 minutes. The system with counterweights does not increase pain. The Heath and Moisture Exchangers (HME) Filters and tubes with smooth inner surface decrease the level of noise in the helmet from 70 to 48 decibel, with a gas flow of 30 l/min. The humidification and warming of gases (26 degrees C (-2 gradient) and warmed tubes) delivers a relative humidity of 33.9 +/- 1.9 mgH2O/l thus avoinding the steaming of the helmet. CONCLUSIONS: The use of counterweights, HME filters, tubes with smooth surface, ear plugs to reduce the noise level and active humidification and warming of gases reduce the discomfort associated to H-CPAP.