Difficulties Faced by the Healthcare Workers Wearing Personal Protective Equipments in COVID-19 Pandemic during Summers of Mumbai City

Abstract

Introduction: The coronavirus pandemic poses a massive challenge for the healthcare system and overburdens the Healthcare Workers (HCWs) in a developing country like India. The coronavirus may survive on various surfaces and/or aerosols for hours to days, making it a necessity to use Personal Protective Equipment (PPE) while treating infected patients. Wearing the PPE is often uncomfortable while working, more so in the summer season, when the temperatures in a tropical country like India are soaring. Aim: To identify, quantify and highlight the difficulties faced by the HCWs while wearing PPEs. Materials and Methods: This descriptive cross-sectional study was conducted in June 2020, by a team of researchers working in a government owned designated Coronavirus Disease- 2019 (COVID-19) hospital in metropolitan city, West India. The questionnaire was prepared for a multicentre survey for 230 HCWs who had used PPE kits during their COVID-19 duties. The online questionnaire responses were recorded in an Microsoft Excel sheet and the results were analysed using Statistical Package for the Social Sciences (SPSS) software version 19.0. Results: Total 230 responses were received out of which 74% were doctors, 21.7% nurses and 4.3% paramedical staff. The mean duration of work was 6.24 hours and per duty one, PPE was used by almost all of the respondents. The most common difficulty faced by the responders while on duty was excessive sweating (96%/n-221), itching of the nose (56%/n-129) and face (50.9%/n-117). While after the duty 61.7% of respondents reported being dehydrated and 68.2% complained of de novo headache. In a subset with a history of migraine, almost all reported worsening of migraine with increased frequency and severity of attacks. Many (40%) reported occasionally lowering the masks or face shield due to unbearable heat, risking self- contamination. Conclusion: The PPEs in current use and in the hot and humid conditions of summer months in tropical countries poses a unique challenge for the HCWs. Customisation of PPEs and working conditions is essential in the mitigation of the problems faced by the HCWs.

Impacts for Health and Care Workers of Covid-19 and Other Public Health Emergencies of International Concern: Living Systematic Review, Meta-analysis & Policy Recommendations

“…Actually, the use of PPE tended to induce de novo headaches and migraines or worsen pre-existing ones, a couple of hours after the end of the shift (204,205).…”

Facial dermatoses induced by face masks: A systematic review and meta‐analysis of observational studies

“…After these exclusions, 37 published studies were included in the meta‐analysis. 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 …”

“…After assessing full‐length articles, 20 studies were excluded for the following reasons: did not provide usable statistics 8–10 ( n = 3), characterized the dermatoses poorly or did not specify the location of dermatoses 11–24 ( n = 14), only included patients presenting to dermatological clinic already with mask‐related dermatoses 25 ( n = 1), all patients had pre‐existing facial dermatoses 26,27 ( n = 2). After these exclusions, 37 published studies were included in the meta‐analysis 28–64 …”

Impacts for health and care workers of Covid-19 and other public health emergencies of international concern: living systematic review, meta-analysis and policy recommendations

“…PHEICS often require HCW to use sophisticated PPE (e.g., gloves, respirators, eye protection, face shields masks, full body suites) more frequently and for prolonged periods of time, which seemed to be associated with dermatitis, pressure injuries, excessive heating and sweating, headaches and/or migraines, breathing difficulties, itching, cracking, burning, flaking, peeling and/or rash [195][196][197][198][199][200][201][202][203], although complaints varied greatly with the equipment used. Actually, the use of PPE tended to induce de novo headaches and migraines or worsen pre-existing ones, a couple of hours after the end of the shift [204,205].…”