The bruised faces of healthcare workers have become a badge of courage, the price they are willing to pay for wearing respirators, masks, and other personal protective equipment (PPE) over long work shifts caring for COVID-19 patients.

The National Pressure Injury Advisory Panel (NPIAP), an independent, not-for-profit professional organization, has issued some general guidance to help healthcare workers — with the caveat that PPE effectiveness must not be compromised.

“The same mechanical forces (i.e., pressure and shear) that cause pressure injuries in our patients are now causing pressure injuries in fellow healthcare providers wearing PPE masks, face shields, and goggles for long periods of time,” the NPIAP stated. “N95 respirator masks have a particularly high risk for injury due to requirements for a tight fit. Skin injury can also occur as a result of friction and the accumulation of moisture under the mask.” (The guidance can be found at: https://cdn.ymaws.com/npiap.com/resource/resmgr/position_statements/Mask_Position_Paper_FINAL_fo.pdf.)

Using a liquid skin protectant may help prevent friction injuries without interfering with the fit of the N95 mask. “The NPIAP does not recommend the use of petroleum jelly, mineral oil, or any other compound that could enhance slippage and affect the function of the mask,” the guidance stated.

Another helpful measure is periodically relieving the pressure of the mask, washing hands before and after.

“Reduce pressure by removing the mask from your face for 15 minutes every two hours outside of areas of patient contact,” the NPIAP recommended. “If this time frame is not practical, attempt to lift the mask by the sides for five minutes every two hours. Any pressure relief will be helpful. Wash hands before and after touching mask.”

Skin abrasions can be treated with topical moisturizers, and “thin occlusive dressings may be used to protect open wounds if they do not interfere with the mask seal,” the panel concluded.