新型冠状病毒肺炎疫情期间医护人员皮肤损伤流行病学调查及特征分析

【摘要】 目的 调查抗击新型冠状病毒肺炎（COVID-19）疫情的一线医护人员皮肤损伤流行病学特征。方法 设计调查问卷，并通过“问卷网”网站发布问卷，于2020年3月10 - 20日通过微信向解放军中部战区总医院收治COVID-19确诊患者的6个感染病区病房的一线医护人员推送问卷。回收问卷，建立数据库，对医护人员的皮肤损伤发生率、损伤类型及流行病学特征进行统计分析。结果 共调查约550名医护人员，收集调查问卷404份，有效问卷391份，其中303例出现皮肤损伤。调查结果显示，女性、手部清洁频率＞10次/d、穿戴三级防护装备时长＞6 h/周均是出现皮肤损伤的危险因素，经常使用护手霜可减少皮肤问题的发生。被调查者中女性皮肤损伤发生率为79.81%（249/312），男性为38.35%（54/79）（χ2 = 4.741，P = 0.029）。手部清洁频率10 ~ 20次/d组［79.73%（118/148）］及＞20次/d组（85.71%，84/98）皮肤损伤发生率高于1 ~ 10次/d组［69.66%（101/145），χ2 = 9.330，P = 0.009］。穿戴防护装备时长1 ~ 5 h/周组皮肤损伤发生率（64.04%，73/114）低于6 ~ 10 h/周组（81.48%，66/81）、11 ~ 15 h/周组（95.24%，20/21）、16 ~ 20 h/周组（81.82%，36/44）、21 ~ 25 h/周组（86.49%，32/37）、＞25 h/周组（80.85%，76/94），差异有统计学意义（χ2 = 19.164，P = 0.002）。391例被调查者中，消毒和防护装备相关皮肤损害集中表现为皮肤干燥（72.89%）、脱屑（56.78%）、皮肤压力性损伤（54.48%）、皮肤浸渍（45.01%）、敏感性皮肤（33.50%），相关皮肤病按照发生率由高到低依次为痤疮（27.11%）、面部皮炎（23.27%）、湿疹皮炎（21.48%）、毛囊炎（18.92%）、皮肤真菌病（11.00%）、荨麻疹（9.21%）等。结论 抗击COVID-19的一线医护人员防护装备相关皮肤损伤发生率高，加强皮肤的保护措施可以显著降低皮肤损伤的发生率。

Characteristics of skin damage among healthcare workers during COVID-19 pandemic: an epidemiological survey

【Abstract】 Objective To investigate epidemiological features of skin damage among front-line healthcare workers fighting against COVID-19 pandemic. Methods A self-designed questionnaire was released on an online survey website “wenjuan.com”, and sent to the front-line medical staff caring for patients with confirmed COVID-19 in 6 infectious disease wards of the General Hospital of Central Theater Command of PLA via WeChat from March 10th to 20th, 2020. Then, the questionnaires were collected, a database was established, and statistical analysis was performed on the incidence, types and epidemiological characteristics of skin damage among the medical staff. Results A total of about 550 medical staff were surveyed, 404 questionnaires were collected, of which 391 were valid, and 303 cases had skin damage. The survey showed that females, hand cleaning frequency > 10 times per day, wearing three-level protective equipment for more than 6 hours per week were risk factors for skin damage, and frequent use of a hand cream could reduce skin problems. Among the respondents, the incidence of skin damage was significantly higher in the females （79.81%, 249/312） than in the males （38.35%, 54/79; χ2 = 4.741, P = 0.029）, and higher in the groups with hand cleaning frequency of 10 - 20 times per day （79.73%, 118/148） and > 20 times per day （85.71%, 84/98） than in the group with hand cleaning frequency of 1 - 10 times per day （69.66 %, 101/145; χ2 = 9.330, P = 0.009）. The incidence of skin damage was significantly lower in the group wearing protective equipment for 1 - 5 hours per week （64.04%, 73/114） than in the groups wearing protective equipment for 6 - 10 hours per week （81.48%, 66/81）, 11 - 15 hours per week （95.24%, 20/21）, 16 - 20 hours per week （81.82%, 36/44）, 21 - 25 hours per week （86.49%, 32/37）, and > 25 hours per week （80.85%, 76/94; χ2 = 19.164, P = 0.002）. Among the 391 respondents, the skin damage related to disinfection and protective equipment mainly manifested as dry skin （72.89%）, desquamation （56.78%）, skin pressure injury （54.48%）, skin maceration （45.01%）, and sensitive skin （33.50%）; acne （27.11%） was the related skin disease with the highest incidence, followed by facial dermatitis （23.27%）, eczematous dermatitis （21.48%）, folliculitis （18.92%）, dermatomycosis （11.00%）, urticaria （9.21%）, etc. Conclusion There was a high incidence of skin damage related to protective equipment among the front-line healthcare workers fighting against COVID-19, and strengthening skin protection could markedly reduce the incidence of skin damage.