Use of Thin Dressings Under N95 Respirators: Exploring Their Effect on Quantitative Fit Testing Results to Guide Hospital Practice During the COVID-19 Pandemic

Abstract

At the beginning of the coronavirus disease-19 pandemic, health care staff at a level 1 trauma center in the state of New York experienced facial irritation and skin breakdown under their N95 respirators due to increased and prolonged use. PURPOSE: Members of the Certified Wound and Ostomy Nurse, Nurse Practitioners staff were charged with developing recommendations within 48 hours to help prevent and manage facial skin issues using available products that would not compromise the seal of the respirators. METHOD: With the assistance of a health care safety specialist from the Environmental Health and Safety Department of the hospital, an ambient particle counting device was used to measure the N95 fit factor following application of a liquid skin barrier, transparent film dressing, light silicone-based adhesive dressing, or an extra-thin hydrocolloid dressing on the bridge of the nose and the cheekbones underneath an N95 respirator of 2 hospital staff members who volunteered to test the dressings. RESULTS: All thin dressings tested showed a fit factor over 100, reflecting an effective seal. The highest fit factors were seen with the liquid skin barrier in the 2 volunteers (200 and 198, respectively). Thin dressing usage information was included in the hospital guidelines for N95 respirators and shared with staff. Subsequent feedback suggests that the light silicone-based adhesive dressing and the extra-thin hydrocolloid dressing were preferred. CONCLUSION: Thin dressing use may help reduce skin complications among hospital staff during periods of extended N95 respirator wear time. Because use of the dressings did not result in failure of the quantitative fit test, they were permitted for use by health care staff under their N95 respirators. Studies are needed to help health care facilities optimize N95 respirator use to protect staff from coronavirus disease-19 and respirator-related skin complications while supply shortages remain.