Covid-19: countermeasure for N95 mask-induced pressure sore.

To the editor

As known to all, World Health Organization has declared on March 11th, 2020 that Coronavirus (Covid‐19) epidemic could be characterized as a pandemic, which proposed a big challenge for healthcare works worldwide, especially doctors and nurses. The strong infectiousness of SARS‐CoV‐2 forces medical personnel to do good and needful safeguard against virus. The N95 Health Care Particulate Respirator and Surgical Mask (Fig. 1a) is the commonly used and effective protective equipment for preventing respiratory virus infection while working in isolation ward. However, in actual course of use, we found N95 mask would bring besetment to users, sometimes inevitably.

Figure 1

(a) N95 health care particulate respirator and surgical mask. (b) Pressure sore on nose bridge. (c) Application of benzalkonium chloride patch on nose bridge.

The upward side of N95 mask has a metal strip on outer side and decompressing banding on inner side. The metal strip needs to be extruded to cling to nose bridge to reach good respiratory protection; however, pressure sore on nose bridge is liable to occur while working for long time, generally more than 4–6 h, although decompressing banding exists (Fig. 1b). The pressure sore could bring intense discomfort to user, and continuous working and wearing mask would further make sore more serious and even sick leave which would bring adverse impact on medical service system of various countries presently.

Hydrocolloid dressing is often used to prevent and cure pressure sore, which is pasted to nose bridge before wearing mask, but we found the strong stickiness of dressing would likely aggravate existent pressure sore when taking off the mask and ripping away the dressing. If pressure sore does occur, the result of wearing N95 mask and using hydrocolloid dressing every day or other day would be from bad to worse.

An improved method involving double protection that pasting benzalkonium chloride patch to the pressure sore on nose bridge firstly and using hydrocolloid dressing secondly before wearing mask (Fig. 1c). The high stickiness of both sides of benzalkonium chloride patch can keep the patch fastened to nose bridge, while the central part can protect the existent pressure sore due to decompressing effect and infection prevention and the low stickiness of central part would not make pressure sore more serious when ripping away the patch.

However, above‐mentioned method is only an expedient measure, improving protective mask is a permanent solution. Although Covid‐19 will eventually be controlled and even eliminated worldwide, there are liable to face new epidemic situation in the future, and any improvement on protective equipment would be meaningful and benefit global health.

Acknowledgement

The patient in this manuscript has given written informed consent to publication of his case details.