A Web Survey to Evaluate the Thermal Stress Associated with Personal Protective Equipment among Healthcare Workers during the COVID-19 Pandemic in Italy

Abstract

The pandemic has been afflicting the planet for over a year and from the occupational point of view, healthcare workers have recorded a substantial increase in working hours. The use of personal protective equipment (PPE), necessary to keep safe from COVID-19 increases the chances of overheating, especially during the summer seasons which, due to climate change, are becoming increasingly warm and prolonged. A web survey was carried out in Italy within the WORKLIMATE project during the summer and early autumn 2020. Analysis of variance (ANOVA) was used to evaluate differences between groups. 191 questionnaires were collected (hospital doctor 38.2%, nurses 33.5%, other healthcare professionals 28.3%). The impact of PPE on the thermal stress perception declared by the interviewees was very high on the body areas directly covered by these devices (78% of workers). Workers who used masks for more than 4 h per day perceived PPE as more uncomfortable (p < 0.001) compared to the others and reported a greater productivity loss (p < 0.001). Furthermore, the study highlighted a high perception of thermal stress among healthcare workers that worn COVID-19-PPE and this enhances the need for appropriate heat health warning systems and response measures addressed to the occupational sector.

Heat Strain and Use of Heat Mitigation Strategies among COVID-19 Healthcare Workers Wearing Personal Protective Equipment—A Retrospective Study

“…It is therefore no surprise that almost all healthcare workers (93% of healthcare workers) experienced heat strain symptoms during COVID-19 medical duties with PPE, and that this prevalence was significantly higher compared to similar medical duties without PPE (30% of healthcare workers). These findings reinforce initial observations from UK, Italy, Singapore and India [5][6][7] and emphasize the magnitude of PPE-induced heat strain among healthcare workers.…”

“…For example, a survey distributed among British healthcare workers (n = 224) revealed that 93% of the respondents experienced multiple heat strain symptoms (i.e., thermal discomfort, headache, fatigue, excessive sweating), whereas 65% and 76% experienced that heat stress impaired their cognitive and physical performance, respectively [5]. Similar observations were made in healthcare workers (n = 356) from Singapore, India and Italy, as thirst, excessive sweating, exhaustion, and desire to go to comfort zones were often reported [6,7]. An important limitation of these studies is the lack of insight into the prevalence of these complaints in the pre-COVID era (i.e., during similar medical duties but without PPE), which hampers the interpretation of the data.…”

“…The PPE allows, by design, almost no ventilation, which impedes both convective and evaporative heat loss and results in a rise in core temperature and indirectly high sweat rates [1,5,6]. Therefore, the combination of the exacerbated workload and the impermeable nature of the PPE might result in extensive increments in perceived heat strain among healthcare workers [1,7,8].…”

Risk of Dehydration Due to Sweating While Wearing Personal 2 Protective Equipment in COVID-19 Clinical Care: A Pilot Study

“…In this sense, the use of protective equipment increases the temperature of the body surface, and the sensation of heat and perspiration, as shown by different investigations [ 27 , 28 , 29 ], conditions the appearance of thermal stress in PPE users. Our research shows that both types of PPE cause an increase in the sensation of heat; however, it was higher in the PPE-Conv users than the PPE-PAPR users.…”

Thermal discomfort caused by personal protective equipment in healthcare workers during the delta COVID-19 pandemic in Guangzhou, China: A case study

“…Therefore, it was more meaningful to have the "neutral group" be included in the "comfortable group,” to compare the "comfortable group" and the "uncomfortable group." Because they felt comfortable or neutral, it showed that the PPE had almost no effect on their work, but the subjects in the "uncomfortable group" had heat stress after wearing PPE, resulting in physical and psychological effects and some symptoms [ [13] , [14] , [15] , [16] ]. The "uncomfortable group" was our main focus in this study.…”