Background: The impact of COVID-19 on skin integrity in an intensive care setting is a challenge due to the pathological acuity and extended length of stay experienced by this patient group. Objectives: The objectives of this study were: to establish the prevalence of skin injury (pressure ulcers [PU], moisture-associated skin damage [MASD], or medical device-related pressure ulcers [MDRPU]) in a cohort of COVID-19 patients admitted to a specialist respiratory intensive care unit during the first COVID-19 surge in early 2020; to establish the prevalence of skin injury in respiratory failure patients supported with extracorporeal membrane oxygenation (ECMO) and respiratory failure patients not supported with ECMO; and to establish if there were significant variances between actual skin injuries experienced by patients and the number recorded through formal incident reporting systems. Methods: We conducted a retrospective skin injury audit of the electronic patient record of every patient who tested positive for COVID-19 and was admitted to the intensive care unit between 16 March 2020 and 26 June 2020. Results: Of 100 patients identified, 64% experienced at least one or more PU, MASD or MDRPU. Of 64 patients not supported with ECMO, at least one or more skin injuries were experienced by 52% of patients. Of 36 patients supported with ECMO, 89% experienced one or more skin injury. 43% of patients who required an incident report for skin damage had one submitted. Conclusion: In COVID-19 ICU patients, skin injury was a frequent complication encountered during their admission. PU prevalence data derived from formal incident reporting systems alone may not represent the extent of skin injury experienced by patients and misrepresents the challenge and resources required to support skin injury preventative strategies in COVID-19 ICU patients. Further study exploring the impact of streamlined skin protection protocols to prevent injury is required.