Skin irritation, exacerbation of skin conditions, and pressure injuries following use of disposable respirators have been widely reported since the beginning of the pandemic, and while some people have found their skin has adjusted, or they have swapped respirator models, not everyone has overcome these challenges.
Many solutions have been offered for skin irritation and injuries resulting from respirator use, including lotions, barrier creams and hydrocolloid dressings, however this advice does not consider the function of respirators, and these interventions can compromise the seal of a respirator on your face – necessary to keep you safe! Additionally, facial irritation and injuries may be indicative of issues with the appropriateness of a respirator for an individual, or a result of extended use.
What is a respirator and how does it protect me?
Respirators are designed to protect the wearer and prevent the inhalation of contaminated air. The most common type used in healthcare is the disposable particulate filtering half-facepiece respirator such as an N95 or P2. They filter out particles in the air during inhalation and rely on facial fit with a satisfactory seal to prevent inward leakage of contaminants.
For respirators to protect you, they must form an airtight seal on the face, so any inhaled air is filtered through the respirator material. If a seal is not achieved, airborne particles can enter your breathing zone through the gaps, and then you may be exposed to the respiratory hazard you are trying to avoid, like an airborne virus.
Why is my skin suffering?
You may have worked out some of the causes of your skin distress, and we have all heard of ‘maskne’ but there is more at play than just acne and they are often caused by a number of factors and compounded by your predispositions and skin type.
Friction and rubbing from the movement of a mask against your face, causes damage to the skin barrier, irritant dermatitis, and mechanical acne and can exacerbate conditions such as perioral dermatitis and rosacea.
Heat, moisture and humidity, from exhaled breath, sweat, can cause miliaria, irritant dermatitis, and may exacerbate perioral dermatitis, acne, rosacea, and seborrheic dermatitis. The use of skin occlusive cosmetics contributes to the development of conditions such as acne, miliaria, and perioral dermatitis. Chemicals or components of the mask or respirator can cause irritant or allergic dermatitis.
Respirators exert pressure on the face in forming a tight facial seal and pressure injuries and bruising can occur on the nose bridge and cheeks and are commonly caused by tightening of the respirator fit or over adjusting the nose wire in an attempt to improve the fit, or from the interaction of a respirator with spectacles or goggles. The fit-testing process is designed to weed out respirators that cause these problems.
What is fit testing and why do I need it?
Fit testing is a requirement under Australian and International Standards where tight-fitting respirators are used. Fit testing is necessary to ascertain that the expected level of protection can be provided and that the respirator model can reliably and adequately seal to an individual’s face. Fit-testing is performed to established standards and approved protocols.
An integral component of the fit-testing process is the comfort check where pressure areas are identified and uncomfortable respirators ruled out, as well as demonstrating correct donning and how to adequately mould the nose wire, without going overboard. By being fit tested you can be reassured you are protected and have a seal without over adjusting or over moulding the nose wires and squishing your poor nose.
Fit testing needs to be performed while wearing any other headwear including PPE (goggles) and spectacles, to ensure they work together and don’t impair the respirator seal. If they are not compatible, the respirator is not a fit for you.
Why are modifications bad and what is the problem with creams?
Donning your fit-tested respirator should be done in a methodical way, the same way every time in accordance with manufacturer’s instructions and as performed during fit-testing, so you can replicate tested fit as closely as possible. For the same reason, respirators must never be modified such as shortening of straps, adding foams, tapes, or materials as this impacts the fit and function of the respirator and your protection.
Fit tests shall not be conducted with modifications to the respirator, or any foreign materials or substance on the face, as these factors cannot be standardised and replicated reliably so the results cannot be applied to other occasions. Respirators must only be used as per manufacturer instructions.
Creams, gels, and other cosmetics (makeup, sunscreen, barrier creams) unfortunately impact the quality of the seal of the respirator to your face and must not be used. Where there is a substance between your skin and the sealing surface of the respirator, the seal can be impaired, and is not recommended. It is possible that a very light lotion that is applied long in advance and has fully absorbed into the skin may be ok, but be mindful using anything that could become greasy, absorb moisture from sweat and your breath and become slimy or slippy, will prevent the seal being achieved and you’re your protection is diminished.
3M have produced two products that are compatible for use with their respirators ‘when used correctly’; 3M Cavilon No Sting Barrier Film is a solution that dries completely to form a film protecting intact skin from moisture and friction, and Advanced Skin Protectant helps protect superficially damaged skin when wearing a 3M respirator. Cavilon Barrier Cream is designed for general applications including incontinence care and severely dry skin, and is not suitable for use with respirators.
Always refer to manufacturer instructions on compatible products and avoid using products or wearing the respirator in any way other than recommended by manufacturer. Ensure you have been fit-tested with any compatible products to ensure the respirator seal on your face is unaffected with their use.
What’s the best approach to safely prevent skin problems?
Get fit-tested, only use fitted respirators, and use them as instructed.
Take regular breaks in a safe outdoor ventilated environment without your respirator (this is about health and safety) to relieve pressure and get some fresh air on your face. Rinse the skin with cool or tepid water each break and use a soap free gentle cleanser at the end of the day. Change your respirator when it becomes moist or damp.
Don’t use cosmetics when wearing a respirator including sunscreens, ointments and barrier creams. Your skin will be easier to clean between breaks and will prevent the accumulation of irritants and occlusive films. Be mindful of lip balms that may migrate over your face due to mask or respirator movement. Clean dry skin ensures the best fit and protection.
What to do if you develop problems with a respirator or your skin.
- Report the issue to your manager or supervisor immediately
- Complete a hazard/incident report of your discomfort or injury
- Seek medical advice and treatment. Be careful, some skin problems look the same but require very different treatment
- Take leave to allow skin time to heal. The earlier the better.
- You may need another fit-test to find an option that will not cause you the same problems
- Make a worker’s compensation claim for work-related injury or disease – yes this includes occupational dermatological conditions!
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This article was provided by Emma Dalton RN, Nurse Immuniser, CertIV(WHS), BNurs, GradDipCosmeticNursing. She is a registered nurse with a background in Emergency, Medical Imaging, and specialises in Dermatology and Occupational Health and Safety. She is currently working in the Health and Safety department at a major metro hospital. Her previous job was Occupational Health Nurse Supervisor in the Respiratory Protection Program of a major hospital network. Emma is passionate about the health, safety and wellbeing of our colleagues, and is on a mission to make OHS a priority in the health sector. It is her belief that not only is caring for health care workers morally and legally necessary, it is also the way to achieve the best outcomes for the people we care for. Emma is an ANMF (Victorian Branch) member, previously a HSR and job rep, and was awarded the Vi Elliott Occupational Health Nurses trust award in 2020.