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COVID 19 Skin Manifestation in the Acute Care Setting
C. Culleton, A. Feinstein, M. Gunning, D. Loehner, M. Melina, M Norberg
Beth Israel Deaconess Medical Center, Boston, MA
Introduction/Problem
The Interventions
* March 2020 World Health Organization declared a global pandemic
* Massachusetts was one of the first states affected by COVID 19
* Skin impairments noted on COVID 19 patients evolved differently from Deep
Tissue Injury (DTI) despite similar appearance.
* COVID 19 skin impairments were identified on areas on the body that were not
on pressure points.
* Review of literature: dearth of data related to novel virus
* NPIAP white paper validated our suspicions that these skin manifestations were
a result of a systemic process . Patients had coagulopathies, multisystem
organ failure , hemodynamic instability
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Prevent pressure injuries
Optimize nutrition
Meticulous local wound care
Safety for patients and staff
Wound care for COVID 19 patients was approached with a conservative manner honoring the principles
of topical therapy
Bundled Care: repositioning patients every 4 hours, decreasing amount of PPE used by staff,
decreasing exposure
Education: pictorial resources for pressure injury prevention, application of foam dressings and offloading techniques
A mobile cart for the proning team and ICU staff. This cart included a checklist and readily available
supplies
Alternate air mattresses from in-house distribution
Debridement avoided due to risk of bleeding; conservative topical therapy
Results/Progress to Date
Aim/Goals
The Team
Covid skin Manifestation: top down injury located on soft tissue , lacy appearance , intact and non-intact
skin with epidermal sloughing to reveal partial thickness skin loss. Lesions very friable
D. Loehner
A.Feinstein
C. Culleton
M. Gunning
M. Melina
M. Norberg
For more information, contact:
Donna Loehner RN BSN CWON Clincal Director Wound Ostomy Nursing Team
�COVID 19 Skin Manifestation in the Acute Care Setting
C. Culleton, A. Feinstein, M. Gunning, D. Loehner, M. Melina, M Norberg
Beth Israel Deaconess Medical Center, Boston, MA
More Results/Progress to Date
Impaired blood flow to epidermis due to COVID 19 systemic coagulopathies. Top down injury that can
lead to partial or full thickness skin loss.
Covid skin manifestations most commonly seen on lower extremities , hands, feet, trunk.
Lessons Learned
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DTPI defined as injuries that can have both intact and non-intact skin with localized area of persistent non
blanching deep red maroon pigment change resulting from prolonged pressure and shearing forces. If
not reversed can evolve into unstageable PI
Tissue Injuries seen on Covid patients appeared as DTPI but were found to have a vascular etiology as
evidence by histological tissue analysis and are now classified as Covid Skin Manifestations
Patients that require proning cannot be placed on low air loss support surfaces, this is a
contraindication
Coagulopathy caused by the Covid -19 virus require a conservative approach to Wound Care, surgical
sharp debridement is to be avoided
Is it possible that not all DTPI's are from pressure but rather from systemic inflammatory conditions?
Next Steps
Education of Medical and Nursing staff on the etiology and management of Covid skin manifestations
Further exploration and research into whether Covid skin manifestations could be classified as Acute Skin
Failure and if so, is this applicable to other critical ill patient populations that develop skin impairments
Further investigation into the progression and deterioration of some Covid skin manifestation into full
thickness wounds
For more information, contact:
Donna Loehner RN BSN CWON Clinical Director Wound Ostomy Team
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Donna Loehner (<a href="mailto:dloehner@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">dloehner@bidmc.harvard.edu</a>)
Project Team
D. Loehner
A. Feinstein
C. Culleton
M. Gunning
M. Melina
M. Norberg
Department
Any departments listed on the poster or identified in the spreadsheet.
Wound Ostomy Nursing Team
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Skin Manifestation in the Acute Care Setting
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness