Patients requiring noninvasive ventilation (NIV) in acute care settings can spend extended periods on respiratory support, increasing the risk of Hospital-Acquired Pressure Injuries (HAPIs), particularly around the nasal bridge, cheeks, and forehead. Skin breakdown is one of the most common complications associated with long-term mask use and can lead to patient discomfort, decreased compliance, and extended stays.
Studies show that HAPIs are associated with a 57% longer length of stay and a 22% higher rate of 30-day readmissions in acute-care settings*.
Respiratory therapists (RTs) and caregivers are challenged to balance effective therapy while protecting skin integrity—especially when a single mask interface is used continuously.
* All data and findings presented in this use case are derived from PubMed Central’s article, Effectively Addressing Hospital-Acquired Pressure Injuries With a Multidisciplinary Approach (October 1, 2024; accessed November 6, 2025), which provides insights into pressure injuries across all body areas, not just facial injuries related to NIV or CPAP mask usage.
Key Challenge
Many NIV patients depend on near-continuous mask usage, and when the same interface is applied repeatedly, pressure is concentrated on the same areas of the skin. Over time, this constant contact can cause irritation, redness, and in severe cases, pressure ulcers.
Maintaining therapy effectiveness while giving vulnerable skin time to recover requires flexibility in interface selection—something many acute care units struggle to achieve without compromising the seal or increasing equipment costs.
The Solution
To proactively manage skin breakdown and improve patient comfort, clinicians implemented a mask rotation strategy using Sleepnet’s Innova® Nasal and Veraseal®3 Full Face Masks.
Each mask provides unique benefits and sealing points:
- Innova® Nasal Mask: Compact design with Sleepnet’s soft AIR°gel® cushion that seals gently around the nose, minimizing friction and pressure.
- Veraseal®3 Full Face Mask: Offers a wider seal footprint that distributes pressure across the cheeks and chin, allowing for different points of comfort.
By alternating between the two interfaces, caregivers are able to shift mask sealing points, allowing the skin to rest while maintaining consistent, effective NIV therapy.
Implementation: How to Mitigate HAPIs
- Step 1: Assess Skin Integrity
Before initiating therapy, RTs perform a baseline skin assessment to identify areas prone to redness or breakdown.
- Step 2: Establish a Rotation Schedule
Masks are alternated every 4–8 hours (or per facility protocol), ensuring that no single area of the face experiences prolonged pressure.
- Step 3: Monitor and Document
RTs record mask changes and skin observations in the patient’s chart, enabling proactive intervention before irritation progresses.
- Step 4: Reassess and Adjust
Based on patient comfort and skin condition, caregivers adjust rotation frequency or alternate between mask types as needed.
This rotation method reduces friction and moisture buildup—two leading contributors to HAPIs—while maintaining consistent therapy compliance.
Conclusion
Alternating between the Innova® Nasal and Veraseal®3 Full Face Masks provides RTs and caregivers with a simple, effective strategy to protect skin integrity during NIV therapy. By rotating interfaces, acute care teams can significantly reduce the occurrence of pressure-related injuries while ensuring uninterrupted, comfortable respiratory support.
Sleepnet’s combination of AIR°gel® cushioning and Custom Fit Technology helps make this approach possible—enhancing patient comfort, therapy success, and overall quality of care.
Resources
- Roderman, N., Wilcox, S., & Beal, A. (2024). Effectively Addressing Hospital-Acquired Pressure Injuries With a Multidisciplinary Approach. HCA healthcare journal of medicine, 5(5), 577–586. https://doi.org/10.36518/2689-0216.1922
- Sleepnet (n.d.), Innova Hospital Nasal Mask, Innova® Hospital Nasal Mask – Sleepnet Corporation
- Sleepnet (n.d.), Veraseal 3 Full Face Mask, Sleepnet Veraseal®3 Full Face Mask – NIV hospital mask interface
