Heat stress associated with aerosol PPE and its impact

Abstract

Background Aerosol personal protective equipment (PPE) is subjectively reported to negatively impact healthcare workers’ performance and well-being, but this has not been assessed objectively. Aims This randomized controlled crossover study aimed to quantify the heat stress associated with aerosol PPE and to investigate its impact upon mood, cognitive and motor function, and task performance. Methods Sixteen healthy, young, lean participants (eight males) undertook an exercise protocol, which simulated the metabolic expenditure of hospital work: once wearing aerosol PPE (PPE visit) and once wearing standard surgical attire (control visit). Participants walked on a treadmill for 2 h followed by 30-min rest. Core temperature, heart rate, urine specific gravity, weight, grip strength, mood (Bond–Lader scale) and task performance (Intubation of a Manikin) were recorded. Values are between-visit mean (standard deviation) differences. Results On the PPE visit core temperature (+0.2 (0.3)°C; P < 0.01), heart rate (+12 (13) bpm; P < 0.001), urine specific gravity (+0.003 (0.005); P < 0.05) and intubation task time (+50 (81) s; P < 0.01) were greater than on the control visit; and alertness (−14 (21) mm; P < 0.001), contentment (−14 (15) mm; P < 0.001) and grip strength (−4 (4) N; P < 0.01) were less. Conclusions This study demonstrates that wearing aerosol PPE in a simulated hospital environment results in heat exhaustion and has a negative impact upon mood, motor function, and task performance. Whilst wearing PPE is important to prevent disease transmission, strategies should be developed to limit its impact upon healthcare workers’ performance and well-being.

Assessment of subjective well-being of healthcare workers in response to heat and personal protective equipment under controlled conditions using a standardized protocol

“…This can impact both physical and cognitive performance [ 3 , 4 , 7 ]. It has been demonstrated that PPE can exacerbate these effects, possibly due to reduced ability to dissipate excess body heat [ 11 , 15 ]. The results of this study are in line with prior publications on HCW exposed to heat while wearing PPE [ 8 , 13 , 14 , 20 ].…”

“…A Dutch study observed that HCW were 25 times more likely to experience heat stress symptoms when performing medical tasks with PPE compared to performing tasks without PPE [ 14 ]. Moreover, a recent study has shown that wearing PPE not only leads to heat exhaustion, but also negatively affects mood, motor function and overall task performance [ 15 ]. Although HCW may be aware of these adverse health effects, the incorporation of best practices for the mitigation of heat stress into daily routines proves challenging, e.g., due to limited staff capacity, infrastructure or funding.…”

“…Other studies lacked the standardization of heat stress exposure due to real-life conditions, potentially obscuring individual effects of heat stress or PPE, such as the ability to self-pace [ 12 , 13 ]. One study investigated the effects of heat stress and wearing PPE under controlled conditions in a laboratory setting [ 15 ]. However, the simplicity of the experimental setup was not comparable to the complex nature of HCW´s real-life tasks.…”