FFP3 Feelings and Clinical Experience (FaCE). Facial pressure injuries in healthcare workers from FFP3 masks during the COVID-19 pandemic.

Aims: Prolonged wear of filtering facepiece 3 (FFP3) masks during the COVID-19 pandemic has led to dermatoses, including pressure sores. This study aimed to better understand the local scale and nature of the problem, coping strategies, and impact on those affected.

Methods: A survey was designed by plastic surgeons, tissue viability nurses, and critical care doctors. Key elements were demographics, mask-wearing behaviours, facial injuries, coping mechanisms, and impacts, such as time off work or redeployment. Question types were multiple-choice questions, visual analogue scales, and blank space. It was distributed for voluntary completion at a London NHS Trust via staff update emails and posters.

Results: Between 24th April-15th May 2020, 178 surveys were completed in full. Participants were 84% female, 55% worked in ITU, and 48% were nurses. Grade 1 facial pressure injuries were reported by 79% of respondents (n=124). Other significant occupational dermatoses included pain (70%), dry skin (50%), and acne (41%). The cheeks and bridge of nose were most affected. Staff used barrier creams (17%), dressings (17%), and analgesia (10%) to manage facial injuries. Half of those who modified their mask were not re-fit tested. A total of 33% required redeployment to a non-FFP3 area or time off.

Conclusions: FFP3 masks worn beyond the recommended 1 h are associated with facial injuries. When advanced PPE (i.e., powered airflow masks) is unavailable, we must provide targeted skincare support (prevent and manage), modify shift patterns to reduce mask wear intensity, and amend fit test protocols to optimise protection against COVID-19.