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Disclosures: The authors report no relevant financial disclosures.
April 08, 2021
2 min read

Frontline health care workers develop ‘care bundle’ that reduces PPE-related injuries

Disclosures: The authors report no relevant financial disclosures.
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Health care workers said a “care bundle” they created that includes WaterWipes, Eucerin Aquaphor Soothing Skin Balm and Mepitac Tape reduced the number of facial pressure injuries caused by prolonged use of personal protective equipment.

To address the “clear and present problem” of PPE-related injuries, Zena Moore, PhD, MSc, director of Health Sciences Skin Wounds and Trauma Research Centre at the Royal College of Surgeons in Ireland’s University of Medicine, and colleagues provided 300 employees within their health system’s COVID-19 wards, ICUs and EDs with a bundle and instructions on how to use it.

The quote is: "Our work to date has shown that the bundle works in reducing the incidence of facial pressure injuries and enhancing comfort.” The source of the quote is: Zena Moore, PhD, MSc.

During the course of the study, “the PPE worn by all types of health care staff and the precise type varied depending on the type of clinical work being undertaken,” Moore told Healio Primary Care.

The bundle was “developed in line with international best practice guidelines,” the researchers wrote in Journal of Wound Care. When using the bundle, Moore and colleagues instructed employees to:

  • use WaterWipes baby wipes to cleanse the facial area;
  • once the skin is cleansed and dry, spread Eucerin Aquaphor Soothing Skin Balm on the same area;
  • cut Mepitac tape to the size of the bridge of their nose and cheekbones and apply.

“The purpose of the tape was to serve as a barrier against the frictional forces endured by those wearing PPE,” Moore and colleagues wrote. “The tape is easy to tear, is breathable and can be applied to different areas of the face.”

According to the researchers, the “pragmatic” decision to use Mepitac tape was based on prior experience with that particular product.

The instructions also encouraged study participants to check their skin and face mask application while working and to examine, clean and moisturize their skin after removing the PPE and tape.

The researchers wrote that after three consecutive shifts of using the bundle, 114 employees responded to a survey that included questions regarding kit satisfaction, areas for improvement and whether they would recommend it to a coworker. Most of the respondents were nurses (n = 68), but physiotherapists (n = 10), health care assistants (n = 9), doctors (n = 6) and other health care workers (n = 11) also took the survey.

According to Moore and colleagues, 33 of the respondents reported developing a facial injury before using the bundle, but only 9 said they developed a facial injury after it (OR for skin injury development = 4.75; 95% CI, 2.15-10.49). Skin tear was the most common injury (n = 4), followed by abrasion (n = 2), blister (n = 2) and deep sore (n = 1). The mean pain score of participants who used the kit was 3.18 out 10, with 10 being the highest amount of pain. In addition, interviews with 14 staff determined that the bundle “was easy to use and safe,” according to the researchers.

“This bundle provided vast numbers of at-risk staff with an all-in-one approach. Our work to date has shown that the bundle works in reducing the incidence of facial pressure injuries and enhancing comfort,” Moore said in the interview. “It is difficult to highlight any particular problems as the different elements of the bundle have worked successfully in tandem.”


Moore Z, et al. J Wound Care. 2021;doi:10.12968/jowc.2021.30.3.162.

Royal College of Surgeons in Ireland. New treatment can reduce facial pressure injuries from PPE in frontline healthcare workers. Accessed April 6, 2021.