Heat Stress and PPE during COVID-19: Impact on health care workers’ performance, safety and well-being in NHS settings

Abstract

Background: The impermeable nature of PPE worn by health care workers (HCWs) during the SARS-CoV-2 (COVID-19) pandemic can potentiate heat stress which may negatively impact the performance, safety and well-being of HCWs. Aim: The aim of this study was to evaluate perceived levels of heat stress and its consequences in HCWs required to wear PPE during the COVID-19 pandemic in the UK. Method: An anonymous online survey was distributed to HCWs required to wear Type 1 or 2 PPE in NHS settings to evaluate the perceived impact of PPE on: (1) physical and cognitive performance; (2) heat stress and heat-related symptoms; (3) frequency of removing PPE due to discomfort caused by heat stress; and (4) general working-life and well-being. Results: The survey received 224 responses from 192 (85.7%) women and 32 (14.3%) men. Even though 71.9% of respondents wore the less thermally challenging PPE (i.e. Type 2), a median of 3 (IQR: 2,5) heat-related symptoms were reported including syncope (7.7%). A median of 1 (IQR: 0-3) cognitive task was adversely affected with attentional focus being the most affected. To relieve discomfort, 32.6% reported removing PPE on five or more occasions in a shift. Ninety two percent reported PPE made their job more difficult and 76.2% advised that physical performance was impaired. Respondents also highlighted concerns of dermatitis and pressure sores in the facial region (22.3%) amongst other factors. Conclusion: Heat stress experienced when PPE is worn negatively impacts the performance, safety and well-being of HCWs and patients. Therefore, modification to current working practices and current design of PPE is urgently required to improve HCWs resilience to pandemics of infectious diseases. Results suggest modifications to the design of the protective face mask and strict enforcement of specific work/rest ratios to limit the duration of PPE use would be immediate impactful interventions.

Cooling vests alleviate perceptual heat strain perceived by COVID-19 nurses

“…Evaporation of sweat further increases sub-PPE absolute humidity, leading to an additional attenuation of evaporative heat loss capacity. In COVID-19 practice, the encapsulation by PPE results in health-care personnel reporting high sweat rates and soaked clothing, making working conditions uncomfortable [ 20 , 21 ].…”

“…Both studies obtained their data during the early stages of the COVID-19 outbreak in China, during which the Chinese health care was overwhelmed and personnel were exhausted due to the shortage of personnel and the intensive, stressful, and long working hours [ 20 , 22 ]. On the other hand, a recent online survey describing the level of perceptual heat strain experienced by COVID-19 health-care personnel wearing PPE in the United Kingdom (UK) demonstrates that 100% of personnel perceived (slightly) hot thermal sensations and ~99% experienced some level of thermal discomfort [ 21 ]. The discrepancy between our perceptual heat strain results and those of the online survey in the UK may be due to differences in PPE wear time, as ~73% of health-care personnel in the UK have work bouts longer than 4 h compared to ~2.5 h in our study population.…”

A web survey to evaluate the thermal stress among healthcare workers during the COVID-19 pandemic in Italy

“…These potential adverse conditions can cause important effects on workers' health and productivity, adding further stress to healthcare systems already under great pressure due to the COVID-19 emergency [3]. Some studies based on surveys to assess the heat stress generated by COVID-19-PPE in the healthcare working sector have already been published internationally [3,4,5]. The main aim of this study was to evaluate the environmental thermal stress perceived by healthcare workers engaged in different activities in order to develop strategies to mitigate the effects of heat conditions, such as the development of a personalized heat-health warning system specific for occupational sectors.…”