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Greenhalgh T, MacIntyre CR, Baker MG, Bhattacharjee S, Chughtai AA, Fisman D, Kunasekaran M, Kvalsvig A, Lupton D, Oliver M, Tawfiq E, Ungrin M, Vipond J. Masks and respirators for prevention of respiratory infections: a state of the science review. Clin Microbiol Rev 2024; 37:e0012423. [PMID: 38775460 PMCID: PMC11326136 DOI: 10.1128/cmr.00124-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - C Raina MacIntyre
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Shovon Bhattacharjee
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, Australia
| | - Abrar A Chughtai
- School of Population Health, University of New South Wales, Sydney, Australia
| | - David Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Amanda Kvalsvig
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Deborah Lupton
- Centre for Social Research in Health and Social Policy Research Centre, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia
| | - Matt Oliver
- Professional Standards Advocate, Edmonton, Canada
| | - Essa Tawfiq
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Ungrin
- Faculty of Veterinary Medicine; Department of Biomedical Engineering, Schulich School of Engineering; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Joe Vipond
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Yang HY, Chou HL, Leow CHW, Kao CC, Daniel D, Jaladara V, Khoe LC, Latha PK, Mahendradhata Y, Nguyen PM, Sirijatuphat R, Soemarko DS, Venugopal V, Zhang K, Lee JKW. Poor personal protective equipment practices were associated with heat-related symptoms among Asian healthcare workers: a large-scale multi-national questionnaire survey. BMC Nurs 2024; 23:145. [PMID: 38429747 PMCID: PMC10905833 DOI: 10.1186/s12912-024-01770-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/28/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND It is pertinent to understand the perceptions of healthcare workers (HCWs) with their associated personal protective equipment (PPE) usage and heat strain symptoms experienced to effectively combat the negative effects of heat stress during treatment and care activities. METHODS We evaluated the associated heat stress perceived by HCWs across Asia and validated a questionnaire on perceptions of heat stress, associated PPE usage, and heat strain symptoms experienced. The questionnaire was administered to 3,082 HCWs in six Asian regions. Factor analyses, including Cronbach's alpha, assessed the questionnaire's validity and reliability. Structural equation modelling analysed the effects of knowledge, attitudes and practices, and heat strain symptoms. RESULTS The questionnaire was found to be reliable in assessing HCWs' knowledge, and attitudes and practices towards heat stress and PPE usage (both Cronbach's alpha = 0.9), but not heat strain symptoms (Cronbach's alpha = 0.6). Despite knowledge of heat stress, HCWs had negative attitudes and practices regarding PPE usage (β1 = 0.6, p < 0.001). Knowledge (path coefficient = 0.2, p < 0.001), and negative attitudes and practices (path coefficient = 0.2, p < 0.001) of HCWs towards heat stress and PPE usage adversely affected symptoms experienced. CONCLUSIONS The questionnaire was not reliable in assessing symptoms. HCWs should, nevertheless, still self-assess their symptoms for early detection of heat strain. To effectively attenuate heat strain, understanding HCWs' attitudes and practices towards PPE usage should guide policymakers in implementing targeted heat management strategies.
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Affiliation(s)
- Hsiao-Yu Yang
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, 10055, Taipei, Taiwan
- Department of Public Health, National Taiwan University College of Public Health, 10055, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, 100225, Taipei, Taiwan
- Population Health Research Center, National Taiwan University, 10617, Taipei City, Taiwan
| | - Hsiu-Ling Chou
- Department of Nursing, Asia Eastern University of Science and Technology, 220303, New Taipei City, Taiwan
- Department of Nursing, Far Eastern Memorial Hospital, 220216, New Taipei City, Taiwan
| | - Clarence Hong Wei Leow
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, 117593, Singapore, Singapore
- Campus for Research Excellence and Technological Enterprise (CREATE), National University of Singapore, 138602, Singapore, Singapore
| | - Ching-Chiu Kao
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, 116079, Taipei, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, 110301, Taipei, Taiwan
| | - D Daniel
- Department of Health Behaviour, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, 55281, Yogyakarta, Indonesia
| | - Vena Jaladara
- Department of Health Behaviour, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, 55281, Yogyakarta, Indonesia
| | - Levina Chandra Khoe
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, 10430, Jakarta, Indonesia
| | - P K Latha
- Sri Ramachandra Institute of Higher Education & Research, 600116, Chennai, Tamil Nadu, India
| | - Yodi Mahendradhata
- Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, 55281, Yogyakarta, Indonesia
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, 55281, Yogyakarta, Indonesia
| | - Phuong Minh Nguyen
- Department of Military Occupational Medicine, Vietnam Military Medical University, Hanoi, Vietnam
| | - Rujipas Sirijatuphat
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Bangkok, Thailand
| | - Dewi Sumaryani Soemarko
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, 10430, Jakarta, Indonesia
| | - Vidhya Venugopal
- Sri Ramachandra Institute of Higher Education & Research, 600116, Chennai, Tamil Nadu, India
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, 12144, Rensselaer, NY, USA
| | - Jason Kai Wei Lee
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, 117593, Singapore, Singapore.
- Campus for Research Excellence and Technological Enterprise (CREATE), National University of Singapore, 138602, Singapore, Singapore.
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, 117593, Singapore, Singapore.
- Heat Resilience and Performance Centre, Yong Loo Lin School of Medicine, National University of Singapore, Block MD9, 2 Medical Drive Level 4, 117593, Singapore, Singapore.
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Wibowo R, Do V, Quartucci C, Koller D, Daanen HAM, Nowak D, Bose-O'Reilly S, Rakete S. Effects of heat and personal protective equipment on thermal strain in healthcare workers: part B-application of wearable sensors to observe heat strain among healthcare workers under controlled conditions. Int Arch Occup Environ Health 2024; 97:35-43. [PMID: 37947815 DOI: 10.1007/s00420-023-02022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE As climate change accelerates, healthcare workers (HCW) are expected to be more frequently exposed to heat at work. Heat stress can be exacerbated by physical activity and unfavorable working requirements, such as wearing personal protective equipment (PPE). Thus, understanding its potential negative effects on HCW´s health and working performance is becoming crucial. Using wearable sensors, this study investigated the physiological effects of heat stress due to HCW-related activities. METHODS Eighteen participants performed four experimental sessions in a controlled climatic environment following a standardized protocol. The conditions were (a) 22 °C, (b) 22 °C and PPE, (c) 27 °C and (d) 27 °C and PPE. An ear sensor (body temperature, heart rate) and a skin sensor (skin temperature) were used to record the participants´ physiological parameters. RESULTS Heat and PPE had a significant effect on the measured physiological parameters. When wearing PPE, the median participants' body temperature was 0.1 °C higher compared to not wearing PPE. At 27 °C, the median body temperature was 0.5 °C higher than at 22 °C. For median skin temperature, wearing PPE resulted in a 0.4 °C increase and higher temperatures in a 1.0 °C increase. An increase in median heart rate was also observed for PPE (+ 2/min) and heat (+ 3/min). CONCLUSION Long-term health and productivity risks can be further aggravated by the predicted temperature rise due to climate change. Further physiological studies with a well-designed intervention are needed to strengthen the evidence for developing comprehensive policies to protect workers in the healthcare sector.
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Affiliation(s)
- Razan Wibowo
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Viet Do
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Caroline Quartucci
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany
- Institute for Occupational Safety and Environmental Health Protection, Bavarian Health and Food Safety Authority, 80538, Munich, Germany
| | - Daniela Koller
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, 81377, Munich, Germany
| | - Hein A M Daanen
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany
| | - Stephan Bose-O'Reilly
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Stefan Rakete
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany.
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Figi CE, Herstein JJ, Beam EL, Le AB, Hewlett AL, Lawler JV, Lowe JJ, Gibbs SG. Literature review of physiological strain of personal protective equipment on personnel in the high-consequence infectious disease isolation environment. Am J Infect Control 2023; 51:1384-1391. [PMID: 37182761 DOI: 10.1016/j.ajic.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Heat strain and dehydration can affect an individual's physical and mental performance. The purpose of this review was to examine the literature for the impact of heat strain on health care workers (HCWs) who care for patients with high-consequence infectious diseases (HCIDs) while wearing personal protective equipment (PPE), discuss the risks of impaired safety caused by heat strain and dehydration in HCID environments, identify attempts to combat PPE-related heat strain, recognize limitations, and provide suggestions for further research. METHODS A literature search was performed in PubMed or MEDLINE and Google Scholar. Authors screened abstracts for inclusion criteria and reviewed articles if the abstracts were considered to include information relevant to the aim. RESULTS The search terms yielded 30 articles that were sorted based on environment setting, physiological impact, and interventions. DISCUSSION The safety of the HCWs and patients can be enhanced through the development and usage of cooler, more comfortable PPE materials and ensembles to help slow the rate of dehydration and support the regulation of core body temperature. CONCLUSIONS Heat strain caused by wearing PPE is an occupational health concern for HCWs in the high-risk environment, that is, HCID care. Future studies are needed to develop innovative PPE ensembles that can reduce heat strain and improve well-being.
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Affiliation(s)
- Claire E Figi
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX.
| | - Jocelyn J Herstein
- Department of Environmental, Agricultural, and Occupational Health, University of Nebraska Medical Center, College of Public Health, 985110 Nebraska Medical Center, Omaha, NE.
| | - Elizabeth L Beam
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE.
| | - Aurora B Le
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI.
| | - Angela L Hewlett
- Global Center for Health Security, University of Nebraska Medical Center, 986161 Nebraska Medical Center, Omaha, NE; Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, 983332 Nebraska Medical Center, Omaha, NE.
| | - James V Lawler
- Global Center for Health Security, University of Nebraska Medical Center, 986161 Nebraska Medical Center, Omaha, NE.
| | - John J Lowe
- Department of Environmental, Agricultural, and Occupational Health, University of Nebraska Medical Center, College of Public Health, 985110 Nebraska Medical Center, Omaha, NE; Global Center for Health Security, University of Nebraska Medical Center, 986161 Nebraska Medical Center, Omaha, NE.
| | - Shawn G Gibbs
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX.
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5
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Crowe J, Knechtle B, Rojas-Valverde D. Editorial: Acute and long-term health issues of occupational exposure to heat and high physical loads. Front Physiol 2023; 14:1304229. [PMID: 37885798 PMCID: PMC10599243 DOI: 10.3389/fphys.2023.1304229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023] Open
Affiliation(s)
- Jennifer Crowe
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional de Costa Rica, Heredia, Costa Rica
| | - Beat Knechtle
- Institute for Family Medicine, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel Rojas-Valverde
- Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD-NARS), Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional de Costa Rica, Heredia, Costa Rica
- Sport Injury Clinic, Escuela Ciencias del Movimiento Humano y Calidad de Vida, Universidad Nacional de Costa Rica, Heredia, Costa Rica
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Tetzlaff EJ, Goulet N, Gorman M, Richardson GRA, Kenny GP. The Intersection of the COVID-19 Pandemic and the 2021 Heat Dome in Canadian Digital News Media: A Content Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6674. [PMID: 37681814 PMCID: PMC10488163 DOI: 10.3390/ijerph20176674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
During the 2021 Heat Dome, 619 people in British Columbia died due to the heat. This public health disaster was made worse by the ongoing COVID-19 pandemic. Few studies have explored the intersection of heat with COVID-19, and none in Canada. Considering that climate change is expected to increase the frequency of extreme heat events, it is important to improve our understanding of intersecting public health crises. Thus, this study aimed to explore media-based public health communication in Canada during the COVID-19 pandemic and the 2021 Heat Dome. A qualitative content analysis was conducted on a subset of media articles (n = 520) related to the COVID-19 pandemic which were identified through a previous media analysis on the 2021 Heat Dome (n = 2909). Many of the articles provided conflicting health messages that may have confused the public about which health protective actions to take. The articles also showed how the COVID-19 pandemic may have exacerbated the health impacts of the 2021 Heat Dome, as pandemic-related public health measures may have deterred people away from protecting themselves from heat. This study, which provides novel insight into the prioritization of public health messaging when an extreme heat event occurs concurrently with a pandemic, supports the need for consistent heat health guidance.
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Affiliation(s)
- Emily J. Tetzlaff
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (E.J.T.); (G.P.K.)
- Heat Division, Climate Change and Innovation Bureau, Healthy Environment and Consumer Safety Branch, Safe Environments Directorate, Health Canada, Ottawa, ON K1A 0K9, Canada;
| | - Nicholas Goulet
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (E.J.T.); (G.P.K.)
- Heat Division, Climate Change and Innovation Bureau, Healthy Environment and Consumer Safety Branch, Safe Environments Directorate, Health Canada, Ottawa, ON K1A 0K9, Canada;
- Behavioural and Metabolic Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Melissa Gorman
- Heat Division, Climate Change and Innovation Bureau, Healthy Environment and Consumer Safety Branch, Safe Environments Directorate, Health Canada, Ottawa, ON K1A 0K9, Canada;
| | - Gregory R. A. Richardson
- Heat Division, Climate Change and Innovation Bureau, Healthy Environment and Consumer Safety Branch, Safe Environments Directorate, Health Canada, Ottawa, ON K1A 0K9, Canada;
| | - Glen P. Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (E.J.T.); (G.P.K.)
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
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7
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Soleimani N, Habibi P, Dehghan H. Effect of air blowing inside isolated hospital clothing on perceptual and physiological heat strain in laboratory conditions. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2023:10.1007/s00484-023-02484-6. [PMID: 37193905 DOI: 10.1007/s00484-023-02484-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/26/2023] [Accepted: 05/04/2023] [Indexed: 05/18/2023]
Abstract
Heat stress is one of the most common complaints of health care employees who wear isolation gowns to protect themselves from biological agents, particularly during the warmer seasons. This study was conducted in a climatic chamber to determine the influence of airflow within isolated hospital gowns on physiological-perceptual heat strain indices. The experiment was conducted in three trials: regular clothes (CON), an impenetrable gown without air blowing (GO), and a gown with air blowing (GO + FAN) at temperature conditions of 27 °C and 25% relative humidity (RH). During the trial, physiological-perceptual response data were recorded for a half-hour on a treadmill at a speed of km/hr and a slope of 0% activity at 5-min intervals. The ASHRAE Likert scale was used to assess thermal comfort (TC), thermal sensation (TS), and skin wetness sensation (WS). As the results show, there was a significant difference in mean scores for TC and WS in both sexes when working in the CON, GO, and GO + FAN groups (P < 0.001). In women, the mean scores for TS, TC, and WS reduced considerably (P < 0.001) in the GO and GO + FAN in the amount of 10 and 12 CFM (20 [Formula: see text]/h), but in males, there was a statistically significant difference between mean scores (P < 0.001) in the GO + FAN at 12 CFM (20 [Formula: see text]/h) and 14 CFM (24 [Formula: see text]/h). Also, the greatest difference between the average heart rate, chest temperature, and temperature inside the clothes in women and men in the trials GO and GO + FAN was observed in the air flow 12 CFM and 14 CFM, respectively (P < 0.001). The usage of an air blower in isolated hospital clothes has been shown to influence physiological-perceptual parameters in men and women substantially. The existence of airflow in these gowns can improve safety, performance, and thermal comfort while also decreasing the risk of heat-related disorders.
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Affiliation(s)
- Negar Soleimani
- Department of Occupational Health Engineering, Research Committee, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peymaneh Habibi
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Habibollah Dehghan
- Department of Occupational Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
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8
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Foster J, Balmain BN, Wilhite DP, Watso JC, Babb TG, Cramer MN, BelvaL LN, Crandall CG. Inhibiting regional sweat evaporation modifies the ventilatory response to exercise: interactions between core and skin temperature. J Appl Physiol (1985) 2023; 134:1011-1021. [PMID: 36892886 PMCID: PMC10110718 DOI: 10.1152/japplphysiol.00597.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023] Open
Abstract
In humans, elevated body temperatures can markedly increase the ventilatory response to exercise. However, the impact of changing the effective body surface area (BSA) for sweat evaporation (BSAeff) on such responses is unclear. Ten healthy adults (9 males, 1 female) performed eight exercise trials cycling at 6 W/kg of metabolic heat production for 60 min. Four conditions were used where BSAeff corresponded to 100%, 80%, 60%, and 40% of BSA using vapor-impermeable material. Four trials (one at each BSAeff) were performed at 25°C air temperature, and four trials (one at each BSAeff) at 40°C air temperature, each with 20% humidity. The slope of the relation between minute ventilation and carbon dioxide elimination (V̇E/V̇co2 slope) assessed the ventilatory response. At 25°C, the V̇E/V̇co2 slope was elevated by 1.9 and 2.6 units when decreasing BSAeff from 100 to 80 and to 40% (P = 0.033 and 0.004, respectively). At 40°C, V̇E/V̇co2 slope was elevated by 3.3 and 4.7 units, when decreasing BSAeff from 100 to 60 and to 40% (P = 0.016 and P < 0.001, respectively). Linear regression analyses using group average data from each condition demonstrated that end-exercise mean body temperature (integration of core and mean skin temperature) was better associated with the end-exercise ventilatory response, compared with core temperature alone. Overall, we show that impeding regional sweat evaporation increases the ventilatory response to exercise in temperate and hot environmental conditions, and the effect is mediated primarily by increases in mean body temperature.NEW & NOTEWORTHY Exercise in the heat increases the slope of the relation between minute ventilation and carbon dioxide elimination (V̇E/V̇co2 slope) in young healthy adults. An indispensable role for skin temperature in modulating the ventilatory response to exercise is noted, contradicting common belief that internal/core temperature acts independently as a controller of ventilation during hyperthermia.
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Affiliation(s)
- Josh Foster
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Bryce N Balmain
- Pulmonary Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Daniel P Wilhite
- Pulmonary Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Joseph C Watso
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Cardiovascular and Applied Physiology Laboratory, Department of Nutrition & Integrative Physiology, Florida State University, Tallahassee, Florida, United States
| | - Tony G Babb
- Pulmonary Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Matthew N Cramer
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Luke N BelvaL
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Craig G Crandall
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
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9
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Effect of the cooling clothing integrating with phase change material on the thermal comfort of healthcare workers with personal protective equipment during the COVID-19. CASE STUDIES IN THERMAL ENGINEERING 2023; 42:102725. [PMCID: PMC9840525 DOI: 10.1016/j.csite.2023.102725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/29/2022] [Accepted: 01/11/2023] [Indexed: 02/18/2024]
Abstract
Wearing Personal Protective Equipment (PPE) is essential to protect healthcare workers during the COVID-19, but the traditional cooling methods do not meet the requirements of epidemic prevention during the COVID-19. Therefore, the cooling clothing integrated with phase change material (PCM-CC) was proposed for healthcare workers performing nucleic acid sample collection outdoors. Human experiments and subjective questionnaires were used to test the effect of wearing PCM-CC on the thermal sensations of healthcare workers and to analyze the effectiveness of PCM-CC in relieving thermal stress and thereby, improving the thermal comfort of healthcare workers. Results showed that wearing PCM-CC was effective in alleviating various heat symptoms associated with wearing PPE in a hot-temperature environment. Wearing PCM-CC reduced head and facial discomfort by 25% and 41% under the 26 °C thermal environment, while it improved the mean thermal sensation vote (TSV) values by 0.71 and 1.85 under the 26 °C and 32 °C thermal environments, respectively, and made the mean TSV value close to the neutral value. Meanwhile, wearing PCM-CC reduced mean skin temperatures by 0.65 °C, and the pronounced cooling effect was found in the chest. Wearing PCM-CC could be an effective thermoregulation measure to refine the thermal comfort of healthcare workers during the COVID-19 pandemic.
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10
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Ciuha U, Valenčič T, Ioannou LG, Mekjavic IB. Efficacy of cooling vests based on different heat-extraction concepts: The HEAT-SHIELD project. J Therm Biol 2023; 112:103442. [PMID: 36796897 DOI: 10.1016/j.jtherbio.2022.103442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION A wide range of cooling vests for heat-strain mitigation purposes during physical work are available on the market. The decision regarding the optimal cooling vest/concept for a specific environment can be challenging by relying solely on the information provided by the manufacturers. The aim of this study was to investigate how different types of cooling vests would manifest/perform in a simulated industrial setting, in a warm and moderately humid environment with low air velocity. METHODS Ten young males completed six experimental trials, including a control trial (no vest) and five trials with vests of different cooling concepts. Once entering the climatic chamber (ambient temperature: 35 °C, relative humidity: 50 %), participants remained seated for 30 min to induce passive heating, after which they donned a cooling vest and started a 2.5-h of walk at 4.5 km·h-1. During the trial, torso skin temperature (Tsk), microclimate temperature (Tmicro) and relative humidity (RHmicro), as well as core temperature (rectal and gastrointestinal; Tc) and heart rate (HR) were measured. Before and after the walk, participants conducted different cognitive tests and provided subjective ratings throughout the walk. RESULTS The use of the vests attenuated the increase in HR (103 ± 12 bpm) when compared to control trial (116 ± 17 bpm, p < 0.05). Four vests maintained a lower torso Tsk (31.7 ± 1.5 °C) compared to control trial (36.1 ± 0.5 °C, p < 0.05). Two vests using PCM inserts attenuated the increase in Tc between 0.2 and 0.5 °C in relation to control trial (p < 0.05). Cognitive performance remained unchanged between the trials. Physiological responses were also well reflected in subjective reports. CONCLUSION Most vests could be considered as an adequate mitigation strategy for workers in industry under the conditions simulated in the present study.
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Affiliation(s)
- Urša Ciuha
- Jozef Stefan Institute, Department of Automatics, Biocybernetics and Robotics, Ljubljana, Slovenia.
| | - Tamara Valenčič
- Jozef Stefan Institute, Department of Automatics, Biocybernetics and Robotics, Ljubljana, Slovenia
| | - Leonidas G Ioannou
- Jozef Stefan Institute, Department of Automatics, Biocybernetics and Robotics, Ljubljana, Slovenia
| | - Igor B Mekjavic
- Jozef Stefan Institute, Department of Automatics, Biocybernetics and Robotics, Ljubljana, Slovenia
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11
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Zhao Y, Su M, Meng X, Liu J, Wang F. Thermophysiological and Perceptual Responses of Amateur Healthcare Workers: Impacts of Ambient Condition, Inner-Garment Insulation and Personal Cooling Strategy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:612. [PMID: 36612933 PMCID: PMC9819836 DOI: 10.3390/ijerph20010612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/16/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
While personal protective equipment (PPE) protects healthcare workers from viruses, it also increases the risk of heat stress. In this study, the effects of environmental heat stress, the insulation of the PPE inner-garment layer, and the personal cooling strategy on the physiological and perceptual responses of PPE-clad young college students were evaluated. Three levels of wet bulb globe temperatures (WBGT = 15 °C, 28 °C, and 32 °C) and two types of inner garments (0.37 clo and 0.75 clo) were chosen for this study. In an uncompensable heat stress environment (WBGT = 32 °C), the effects of two commercially available personal cooling systems, including a ventilation cooling system (VCS) and an ice pack cooling system (ICS) on the heat strain mitigation of PPE-clad participants were also assessed. At WBGT = 15 °C with 0.75 clo inner garments, mean skin temperatures were stabilized at 31.2 °C, Hskin was 60-65%, and HR was about 75.5 bpm, indicating that the working scenario was on the cooler side. At WBGT = 28 °C, Tskin plateaued at approximately 34.7 °C, and the participants reported "hot" thermal sensations. The insulation reduction in inner garments from 0.75 clo to 0.37 clo did not significantly improve the physiological thermal comfort of the participants. At WBGT = 32 °C, Tskin was maintained at 35.2-35.7 °C, Hskin was nearly 90% RH, Tcore exceeded 37.1 °C, and the mean HR was 91.9 bpm. These conditions indicated that such a working scenario was uncompensable, and personal cooling to mitigate heat stress was required. Relative to that in NCS (no cooling), the mean skin temperatures in ICS and VCS were reduced by 0.61 °C and 0.22 °C, respectively, and the heart rates were decreased by 10.7 and 8.5 bpm, respectively. Perceptual responses in ICS and VCS improved significantly throughout the entire field trials, with VCS outperforming ICS in the individual cooling effect.
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Affiliation(s)
- Yingying Zhao
- School of Thermal Engineering, Shandong Jianzhu University, Jinan 250101, China
| | - Meng Su
- School of Thermal Engineering, Shandong Jianzhu University, Jinan 250101, China
| | - Xin Meng
- School of Thermal Engineering, Shandong Jianzhu University, Jinan 250101, China
| | - Jiying Liu
- School of Thermal Engineering, Shandong Jianzhu University, Jinan 250101, China
| | - Faming Wang
- Department of Biosystems, Katholieke Universiteit Leuven, 3001 Leuven, Belgium
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12
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Bonafede M, Levi M, Pietrafesa E, Binazzi A, Marinaccio A, Morabito M, Pinto I, de’ Donato F, Grasso V, Costantini T, Messeri A. Workers’ Perception Heat Stress: Results from a Pilot Study Conducted in Italy during the COVID-19 Pandemic in 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138196. [PMID: 35805854 PMCID: PMC9266050 DOI: 10.3390/ijerph19138196] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022]
Abstract
Many workers are exposed to the effects of heat and often to extreme temperatures. Heat stress has been further aggravated during the COVID-19 pandemic by the use of personal protective equipment to prevent SARS-CoV-2 infection. However, workers’ risk perception of heat stress is often low, with negative effects on their health and productivity. The study aims to identify workers’ needs and gaps in knowledge, suggesting the adaptation of measures that best comply with the needs of both workers and employers. A cross-sectional online questionnaire survey was conducted in Italy in the hottest months of 2020 (June–October) through different multimedia channels. The data collected were analyzed using descriptive statistics; analytical tests and analysis of variance were used to evaluate differences between groups of workers. In total, 345 questionnaires were collected and analyzed. The whole sample of respondents declared that heat is an important contributor to productivity loss and 83% of workers did not receive heat warnings from their employer. In this context, the internet is considered as the main source of information about heat-related illness in the workplace. Results highlight the need to increase workers’ perception of heat stress in the workplace to safeguard their health and productivity. About two-thirds of the sample stated that working in the sun without access to shaded areas, working indoors without adequate ventilation, and nearby fire, steam, and hot surfaces, represent the main injuries’ risk factors.
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Affiliation(s)
- Michela Bonafede
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00143 Rome, Italy; (M.B.); (E.P.); (A.B.); (A.M.)
| | - Miriam Levi
- Epidemiology Unit, Department of Prevention, Local Health Authority Tuscany Centre, 50135 Florence, Italy;
| | - Emma Pietrafesa
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00143 Rome, Italy; (M.B.); (E.P.); (A.B.); (A.M.)
| | - Alessandra Binazzi
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00143 Rome, Italy; (M.B.); (E.P.); (A.B.); (A.M.)
| | - Alessandro Marinaccio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00143 Rome, Italy; (M.B.); (E.P.); (A.B.); (A.M.)
| | - Marco Morabito
- Institute of Bioeconomy, National Research Council (IBE-CNR), 50019 Florence, Italy;
| | - Iole Pinto
- Physical Agents Sector, Regional Public Health Laboratory, 53100 Siena, Italy;
| | - Francesca de’ Donato
- Department of Epidemiology Lazio Regional Health Service, ASL ROMA 1, 00147 Rome, Italy; (F.d.D.); (T.C.)
| | - Valentina Grasso
- LaMMA Consortium—Weather Forecaster and Researcher at Laboratory of Monitoring and Environmental Modelling for Sustainable Development, 50019 Florence, Italy;
| | - Tiziano Costantini
- Department of Epidemiology Lazio Regional Health Service, ASL ROMA 1, 00147 Rome, Italy; (F.d.D.); (T.C.)
| | - Alessandro Messeri
- LaMMA Consortium—Weather Forecaster and Researcher at Laboratory of Monitoring and Environmental Modelling for Sustainable Development, 50019 Florence, Italy;
- Climate and Sustainability Foundation, 50100 Florence, Italy
- AMPRO—Professional Weather Association, 00142 Rome, Italy
- Correspondence: ; Tel.: +39-055-522-6041
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13
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Yang J, Zhang X, Koh JJ, Deng R, Kumarasamy S, Xu YX, Qu H, Zhang S, Zhang Y, Tan SC. Reversible Hydration Composite Films for Evaporative Perspiration Control and Heat Stress Management. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2022; 18:e2107636. [PMID: 35187798 DOI: 10.1002/smll.202107636] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/24/2022] [Indexed: 06/14/2023]
Abstract
Donning of personal protective equipment (PPE) in the healthcare sector has been intensified by the on-going COVID-19 pandemic around the globe. While extensive PPE provides protection, it typically limits moisture permeability and severely hinders the sweat evaporation process, resulting in greater heat stress on the personnel. Herein, a zinc-poly(vinyl alcohol) (Zn-PVA) composite film is fabricated by embedding a super-hygroscopic zinc-ethanolamine complex (Zn-complex) in the PVA matrix. By attaching the Zn-PVA composite film, the relative humidity (RH) inside the protective suit decreases from 91.0% to 48.2%. The reduced RH level, in turn, enhances evaporative cooling, hence bringing down the heat index from 64.6 to 40.0 °C at an air temperature of 35 °C, remarkably lowering the likelihood of heat stroke. The American Society for Testing and Materials tests conducted on a sweating manikin have also proven that the Zn-PVA composite films can significantly reduce the evaporative resistance of the protective suit by 90%. The low material cost, facile fabrication process, and reusability allow the Zn-PVA composition films to be readily available for healthcare workers worldwide. This application can be further extended to other occupations that are facing severe thermal discomfort and heat stress.
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Affiliation(s)
- Jiachen Yang
- Department of Materials Science and Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117575, Singapore
| | - Xueping Zhang
- Department of Materials Science and Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117575, Singapore
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
| | - J Justin Koh
- Department of Materials Science and Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117575, Singapore
| | - Rensheng Deng
- Home Team Science and Technology Agency, 1 Stars Avenue, Singapore, 138507, Singapore
| | - Saravana Kumarasamy
- Home Team Science and Technology Agency, 1 Stars Avenue, Singapore, 138507, Singapore
| | - Yuan Xing Xu
- Home Team Science and Technology Agency, 1 Stars Avenue, Singapore, 138507, Singapore
| | - Hao Qu
- Department of Materials Science and Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117575, Singapore
| | - Songlin Zhang
- Department of Materials Science and Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117575, Singapore
| | - Yaoxin Zhang
- Department of Materials Science and Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117575, Singapore
| | - Swee Ching Tan
- Department of Materials Science and Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117575, Singapore
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14
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Bongers CCWG, de Korte JQ, Zwartkruis M, Levels K, Kingma BRM, Eijsvogels TMH. Heat Strain and Use of Heat Mitigation Strategies among COVID-19 Healthcare Workers Wearing Personal Protective Equipment-A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1905. [PMID: 35162925 PMCID: PMC8834922 DOI: 10.3390/ijerph19031905] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 12/19/2022]
Abstract
The combination of an exacerbated workload and impermeable nature of the personal protective equipment (PPE) worn by COVID-19 healthcare workers increases heat strain. We aimed to compare the prevalence of heat strain symptoms before (routine care without PPE) versus during the COVID-19 pandemic (COVID-19 care with PPE), identify risk factors associated with experiencing heat strain, and evaluate the access to and use of heat mitigation strategies. Dutch healthcare workers (n = 791) working at COVID-19 wards for ≥1 week, completed an online questionnaire to assess personal characteristics, heat strain symptoms before and during the COVID-19 pandemic, and the access to and use of heat mitigation strategies. Healthcare workers experienced ~25× more often heat strain symptoms during medical duties with PPE (93% of healthcare workers) compared to without PPE (30% of healthcare workers; OR = 25.57 (95% CI = 18.17-35.98)). Female healthcare workers and those with an age <40 years were most affected by heat strain, whereas exposure time and sports activity level were not significantly associated with heat strain prevalence. Cold drinks and ice slurry ingestion were the most frequently used heat mitigation strategies and were available in 63.5% and 30.1% of participants, respectively. Our findings indicate that heat strain is a major challenge for COVID-19 healthcare workers, and heat mitigations strategies are often used to counteract heat strain.
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Affiliation(s)
- Coen C W G Bongers
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Philips van Leijdenlaan 15, 6525 EX Nijmegen, The Netherlands
| | - Johannus Q de Korte
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Philips van Leijdenlaan 15, 6525 EX Nijmegen, The Netherlands
| | - Mike Zwartkruis
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Philips van Leijdenlaan 15, 6525 EX Nijmegen, The Netherlands
| | - Koen Levels
- Institute of Training Medicine and Training Physiology, TGTF, Royal Netherlands Army, Herculeslaan 1, 3584 AB Utrecht, The Netherlands
| | - Boris R M Kingma
- Department of Human Performance, Unit Defence, Safety and Security, TNO, The Netherlands Organization for Applied Sciences, Kampweg 55, 3769 DE Soesterberg, The Netherlands
- Department of Energy Technology, Eindhoven University of Technology, Groene Loper 19, 5612 AP Eindhoven, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Philips van Leijdenlaan 15, 6525 EX Nijmegen, The Netherlands
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15
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Chen Y, Zhang C, Lu L, Zheng X, Chang S. Dynamic of upper body sweat distribution in young males wearing fully encapsulated chemical protective ensembles. Sci Rep 2022; 12:990. [PMID: 35046487 PMCID: PMC8770470 DOI: 10.1038/s41598-022-04974-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/04/2022] [Indexed: 11/08/2022] Open
Abstract
Impermeability is a feature of fully encapsulated chemical protective ensembles (FCPE), which can affect people's sweat and affect their clothing's thermal-wet comfort. This study investigated the dynamics of upper-body sweat distribution in young males wearing FCPE and explored variations in sweat rate intra-region and inter-time for 10 young and healthy male college students. The study was carried in a climatic chamber (environment temperature 35 °C, relative humidity 60%) with participants exercising on a treadmill at 4 km/h, 5%. Sweat was collected using a 35-pad set of absorbent pads that were changed every 5 min during the course of the experiment. A total of 7-pad sets were collected with an average sweat rate of 389, 631, 920, 1137, 1100, 1211, and 1105 g m-2 h-1, respectively. The medial upper back, lateral lower back, medial upper chest, medial mid-back, and lateral top back had the highest sweat rates, with average values of 1406, 1278, 1198, 1181 and 1139 g m-2 h-1, respectively. The waist (with average values of 557, 370, 596, and 332 g m-2 h-1, respectively) and bottom zones (373, 398, 661, and 849 g m-2 h-1, respectively) had the lowest sweat rates. The above data showed that the role of FCPE in promoting body perspiration. The upper body may be split into three zones of sweat rates based on the distribution result allowing for the design of more comfortable clothing. The study includes the fundamental physiological data as well as the design recommendations for advanced personal protective equipment.
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Affiliation(s)
- Ying Chen
- School of Fashion, Beijing Institute of Fashion Technology, Beijing, China
- State Key Laboratory of NBC Protection for Civilian, Beijing, China
| | - Chuankun Zhang
- State Key Laboratory of NBC Protection for Civilian, Beijing, China
| | - Lin Lu
- State Key Laboratory of NBC Protection for Civilian, Beijing, China
| | - Xiaohui Zheng
- State Key Laboratory of NBC Protection for Civilian, Beijing, China.
| | - Suqin Chang
- School of Materials Design & Engineering, Beijing Institute of Fashion Technology, Beijing, China
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16
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Herstein JJ, Abdoulaye AA, Jelden KC, Le AB, Beam EL, Gibbs SG, Hewlett AL, Vasa A, Boulter KC, Stentz TL, Kopocis-Herstein KR, ElRayes W, Wichman C, Lowe JJ. A pilot study of core body temperatures in healthcare workers wearing personal protective equipment in a high-level isolation unit. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:430-435. [PMID: 34383620 DOI: 10.1080/15459624.2021.1949459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Personal protective equipment used by healthcare workers to mitigate disease transmission risks while caring for patients with high-consequence infectious diseases can impair normal body cooling mechanisms and exacerbate physiological strain. Symptoms of heat strain (e.g., cognitive impairment, confusion, muscle cramping) are especially harmful in the high-risk environment of high-consequence infectious disease care. In this pilot study, the core body temperatures of healthcare workers were assessed using an ingestible, wireless-transmission thermometer while performing patient care tasks common to a high-level isolation unit setting in powered air purifying respirator (PAPR)-level. The objective was to determine the potential for occupational health hazard due to heat stress in an environmentally controlled unit. Maximum core temperatures of the six participants ranged from 37.4 °C (99.3 °F) to 39.9 °C (103.8°F) during the 4-hr shift; core temperatures of half (n = 3) of the participants exceeded 38.5 °C (101.3 °F), the upper core temperature limit. Future investigations are needed to identify other heat stress risks both in and outside of controlled units. The ongoing COVID-19 pandemic offers unique opportunities for field-based research on risks of heat stress related to personal protective equipment in healthcare workers that can lead to both short- and long-term innovations in this field.
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Affiliation(s)
- Jocelyn J Herstein
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Aurora B Le
- School of Public Health, University of Michigan, Ann Arbor, Ann Arbor, Michigan
| | - Elizabeth L Beam
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska
| | - Shawn G Gibbs
- School of Public Health, Texas A&M University, College Station, Texas
| | - Angela L Hewlett
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | - Terry L Stentz
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
- College of Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Kelli R Kopocis-Herstein
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
- College of Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Wael ElRayes
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Chris Wichman
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - John J Lowe
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
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17
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Bonell A, Nadjm B, Samateh T, Badjie J, Perry-Thomas R, Forrest K, Prentice AM, Maxwell NS. Impact of Personal Cooling on Performance, Comfort and Heat Strain of Healthcare Workers in PPE, a Study From West Africa. Front Public Health 2021; 9:712481. [PMID: 34540787 PMCID: PMC8440920 DOI: 10.3389/fpubh.2021.712481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/10/2021] [Indexed: 01/25/2023] Open
Abstract
Background: Personal protective equipment (PPE) is an essential component of safely treating suspected or confirmed SARS-CoV-2 patients. PPE acts as a barrier to heat loss, therefore increasing the risk of thermal strain which may impact on cognitive function. Healthcare workers (HCWs) need to be able to prioritize and execute complex tasks effectively to ensure patient safety. This study evaluated pre-cooling and per-cooling methods on thermal strain, thermal comfort and cognitive function during simulated emergency management of an acutely unwell patient. Methods: This randomized controlled crossover trial was run at the Clinical Services Department of the Medical Research Unit The Gambia. Each participant attended two sessions (Cool and Control) in standard PPE. Cool involved pre-cooling with an ice slurry ingestion and per-cooling by wearing an ice-vest external to PPE. Results: Twelve participants completed both sessions. There was a significant increase in tympanic temperature in Control sessions at both 1 and 2 h in PPE (p = 0.01). No significant increase was seen during Cool. Effect estimate of Cool was -0.2°C (95% CI -0.43; 0.01, p = 0.06) post 1 h and -0.28°C (95% CI -0.57; 0.02, p = 0.06) post 2 h on tympanic temperature. Cool improved thermal comfort (p < 0.001), thermal sensation (p < 0.001), and thirst (p = 0.04). No difference on cognitive function was demonstrated using multilevel modeling. Discussion: Thermal strain in HCWs wearing PPE can be safely reduced using pre- and per-cooling methods external to PPE.
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Affiliation(s)
- Ana Bonell
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Behzad Nadjm
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Tida Samateh
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Jainaba Badjie
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Robyn Perry-Thomas
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Karen Forrest
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Andrew M. Prentice
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Neil S. Maxwell
- Environmental Extremes Laboratory, University of Brighton, Eastbourne, United Kingdom
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18
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Morrissey MC, Casa DJ, Brewer GJ, Adams WM, Hosokawa Y, Benjamin CL, Grundstein AJ, Hostler D, McDermott BP, McQuerry ML, Stearns RL, Filep EM, DeGroot DW, Fulcher J, Flouris AD, Huggins RA, Jacklitsch BL, Jardine JF, Lopez RM, McCarthy RB, Pitisladis Y, Pryor RR, Schlader ZJ, Smith CJ, Smith DL, Spector JT, Vanos JK, Williams WJ, Vargas NT, Yeargin SW. Heat Safety in the Workplace: Modified Delphi Consensus to Establish Strategies and Resources to Protect the US Workers. GEOHEALTH 2021; 5:e2021GH000443. [PMID: 34471788 PMCID: PMC8388206 DOI: 10.1029/2021gh000443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 06/04/2023]
Abstract
The purpose of this consensus document was to develop feasible, evidence-based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus-based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best-practices and protect worker health and productivity.
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Affiliation(s)
- Margaret C. Morrissey
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Douglas J. Casa
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Gabrielle J. Brewer
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - William M. Adams
- Department of KinesiologyUniversity of North Carolina at GreensboroGreensboroNCUSA
| | - Yuri Hosokawa
- Faculty of Sports SciencesWaseda UniversitySaitamaJapan
| | | | | | - David Hostler
- Department of Exercise and Nutrition SciencesCenter for Research and Education in Special EnvironmentsBuffaloNYUSA
| | - Brendon P. McDermott
- Department of Health, Human Performance and RecreationUniversity of ArkansasFayettevilleARUSA
| | | | - Rebecca L. Stearns
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Erica M. Filep
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - David W. DeGroot
- Fort Benning Heat CenterMartin Army Community HospitalFort BenningGAUSA
| | | | - Andreas D. Flouris
- Department of Exercise ScienceFAME LaboratoryUniversity of ThessalyTrikalaGreece
| | - Robert A. Huggins
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | | | - John F. Jardine
- Department of KinesiologyKorey Stringer InstituteUniversity of ConnecticutMansfieldCTUSA
| | - Rebecca M. Lopez
- School of Physical Therapy & Rehabilitation SciencesMorsani College of MedicineUniversity of South FloridaTampaFLUSA
| | | | - Yannis Pitisladis
- Collaborating Centre of Sports MedicineUniversity of BrightonBrightonUK
| | - Riana R. Pryor
- Department of Exercise and Nutrition SciencesCenter for Research and Education in Special EnvironmentsBuffaloNYUSA
| | - Zachary J. Schlader
- Department of KinesiologySchool of Public HealthIndiana UniversityBloomingtonIAUSA
| | - Caroline J. Smith
- Department of Health and Exercise ScienceAppalachian State UniversityBooneNCUSA
| | - Denise L. Smith
- Department of Health and Human Physiological SciencesFirst Responder Health and Safety LaboratorySkidmore CollegeSaratoga SpringsNYUSA
| | - June T. Spector
- Department of Environmental and Occupational Health SciencesSchool of Public HealthUniversity of WashingtonSeattleWAUSA
| | | | - W. Jon Williams
- Centers for Disease Control and Prevention (CDC)National Personal Protective Technology Laboratory (NPPTL)National Institute for Occupational Safety and Health (NIOSH)PittsburghPAUSA
| | - Nicole T. Vargas
- Faculty of Health SciencesUniversity of SydneySydneyNSWAustralia
| | - Susan W. Yeargin
- Department of Exercise ScienceArnold School of Public HealthUniversity of South CarolinaColumbiaSCUSA
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19
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Jegodka Y, Lagally L, Mertes H, Deering K, Schoierer J, Buchberger B, Bose-O'Reilly S. Hot days and Covid-19: Online survey of nurses and nursing assistants to assess occupational heat stress in Germany during summer 2020. THE JOURNAL OF CLIMATE CHANGE AND HEALTH 2021; 3:100031. [PMID: 35313705 PMCID: PMC8925298 DOI: 10.1016/j.joclim.2021.100031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/18/2021] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Our aim was to identify if working during hot days while wearing Covid-19 related personal protective equipment causes occupational heat stress for nurses and nursing assistants in Germany. DESIGN Using an online survey, we assessed the impact of hot weather on nurses and nursing assistants working with personal protective equipment. Respondents were recruited by distributing the link to the survey via personal communication, email and various social media channels to nursing staff from hospitals, nursing homes and outpatient care. RESULTS There were in total 428 participants (18.2% male, 82.5% female), mostly (30.5%) aged between 45 and 55 years. Half of respondents (48.3%) had more than 20 years of experience in nursing. Cardiac, pulmonary, or other pre-existing conditions were reported by 46.2%.Nurses and nursing assistants working in personal protective equipment during hot days were exposed to occupational heat stress. Work was found exhaustive by 96.5% of the participants during those days. 93.0% reported breathing problems and 85.8% reported difficulties with focusing on their work. Many workplaces did not provide adequate heat protection, with distinct differences concerning the amount of prophylactic and heat mitigating measures across institutions. There were significant differences across institutions when it comes to the number of drinks served (p < 0.001), the availability of room thermometers (p < 0.001), the use of mobile cooling devices (p < 0.001) and fans (p < 0.05). CONCLUSIONS Results suggest employers must make more of an effort to provide adequate heat protection for their nursing staff. In order to ensure patient care, there is a need for action; in particular, attention must be paid to the pre-existing health conditions of the nursing staff.
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Affiliation(s)
- Yvette Jegodka
- FOM University of Applied Sciences, Institute for Health and Social Sciences, Bismarckstr. 107, D-10625 Berlin, Germany
| | - Lena Lagally
- LMU Munich, University Hospital, Institute and Clinic for Occupational, Social and Environmental Medicine, Unit Global Environmental Health and Climate Change, Ziemssenstr. 5, D-80336 Munich, Germany
| | - Hanna Mertes
- LMU Munich, University Hospital, Institute and Clinic for Occupational, Social and Environmental Medicine, Unit Global Environmental Health and Climate Change, Ziemssenstr. 5, D-80336 Munich, Germany
| | - Katharina Deering
- LMU Munich, University Hospital, Institute and Clinic for Occupational, Social and Environmental Medicine, Unit Global Environmental Health and Climate Change, Ziemssenstr. 5, D-80336 Munich, Germany
| | - Julia Schoierer
- LMU Munich, University Hospital, Institute and Clinic for Occupational, Social and Environmental Medicine, Unit Global Environmental Health and Climate Change, Ziemssenstr. 5, D-80336 Munich, Germany
| | - Barbara Buchberger
- FOM University of Applied Sciences, Institute for Health and Social Sciences, Bismarckstr. 107, D-10625 Berlin, Germany
- Robert Koch Institute, Nordufer 20, D-13353 Berlin, Germany
| | - Stephan Bose-O'Reilly
- LMU Munich, University Hospital, Institute and Clinic for Occupational, Social and Environmental Medicine, Unit Global Environmental Health and Climate Change, Ziemssenstr. 5, D-80336 Munich, Germany
- UMIT - Private University for Health Sciences, Medical Informatics and Technology, Institute for Public Health, Medical Decision Making and HTA, Eduard-Wallnöfer Zentrum 1, A-6060 Hall i.T., Austria
- University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John and the University Hospital, University of Regensburg, Steinmetzstr. 1-3, D-93049 Regensburg, Germany
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20
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Bose-O'Reilly S, Daanen H, Deering K, Gerrett N, Huynen MMTE, Lee J, Karrasch S, Matthies-Wiesler F, Mertes H, Schoierer J, Shumake-Guillemot J, van den Hazel P, Frank van Loenhout JA, Nowak D. COVID-19 and heat waves: New challenges for healthcare systems. ENVIRONMENTAL RESEARCH 2021; 198:111153. [PMID: 33857461 PMCID: PMC8056477 DOI: 10.1016/j.envres.2021.111153] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 05/12/2023]
Abstract
Heat waves and Covid-19 overlap, as this pandemic continues into summer 2021. Using a narrative review, we identified overlapping risk groups and propose coping strategies. The high-risk groups for heat-related health problems as well as for high-risk COVID-19 groups overlap considerably (elderly with pre-existing health conditions). Health care facilities will again be challenged by Covid-19 during heat waves. Health care personnel are also at risk of developing heat related health problems during hot periods due to the use of personal protective equipment to shield themselves from SARS-CoV-2 and must therefore be protected from excessive heat periods. Some existing recommendations for heat health protection contradict recommendations for COVID-19 protection. This paper provides a preliminary overview of possible strategies and interventions to tackle these ambiguities. The existing recommendations for protection against heat-related illnesses need revisions to determine whether they include essential aspects of infection control and occupational safety and how they may be supplemented.
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Affiliation(s)
- Stephan Bose-O'Reilly
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany; Institute for Public Health, Medical Decision Making and HTA, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnöfer Zentrum 1, 6060, Hall i.T., Austria; University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John and the University Hospital, University of Regensburg, Regensburg, Germany.
| | - Hein Daanen
- Department of Human Movement Sciences. Faculty of Behavioral and Movement Sciences. Vrije Universiteit Amsterdam. Van der Boechorststraat 7, 1081, BT Amsterdam, the Netherlands
| | - Katharina Deering
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Nicola Gerrett
- Department of Human Movement Sciences. Faculty of Behavioral and Movement Sciences. Vrije Universiteit Amsterdam. Van der Boechorststraat 7, 1081, BT Amsterdam, the Netherlands
| | | | - Jason Lee
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117593, Singapore; Global Asia Institute, National University of Singapore, Singapore; N.1 Institute for Health, National University of Singapore, 28 Medical Dr, Singapore 117456, Singapore; Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute for Digital Medicine, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Centre for Environment and Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Franziska Matthies-Wiesler
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Centre for Environment and Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Hanna Mertes
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Julia Schoierer
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | | | - Peter van den Hazel
- International Network on Children's Health, Environment and Safety (INCHES), Ellecom, the Netherlands
| | - Joris Adriaan Frank van Loenhout
- Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, UCLouvain, Clos Chapelle-Aux-Champs 30, 1200, Woluwé-Saint-Lambert (Brussels), Belgium
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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21
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Messeri A, Bonafede M, Pietrafesa E, Pinto I, de’Donato F, Crisci A, Lee JKW, Marinaccio A, Levi M, Morabito M. A Web Survey to Evaluate the Thermal Stress Associated with Personal Protective Equipment among Healthcare Workers during the COVID-19 Pandemic in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3861. [PMID: 33917051 PMCID: PMC8067771 DOI: 10.3390/ijerph18083861] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/26/2021] [Accepted: 04/04/2021] [Indexed: 01/07/2023]
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.
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Affiliation(s)
- Alessandro Messeri
- Institute of Bioeconomy, National Research Council (IBE-CNR), 50019 Florence, Italy; (A.C.); (M.M.)
- Centre of Bioclimatology, University of Florence (UNIFI), 50144 Florence, Italy
| | - Michela Bonafede
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00143 Rome, Italy; (M.B.); (E.P.); (A.M.)
| | - Emma Pietrafesa
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00143 Rome, Italy; (M.B.); (E.P.); (A.M.)
| | - Iole Pinto
- Physical Agents Sector, Regional Public Health Laboratory, 53100 Siena, Italy;
| | - Francesca de’Donato
- Department of Epidemiology Lazio Regional Health Service, ASL ROMA 1, 00147 Rome, Italy;
| | - Alfonso Crisci
- Institute of Bioeconomy, National Research Council (IBE-CNR), 50019 Florence, Italy; (A.C.); (M.M.)
| | - Jason Kai Wei Lee
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117593, Singapore;
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore S117593, Singapore
- Global Asia Institute, National University of Singapore, Singapore S119076, Singapore
- N.1 Institute for Health, National University of Singapore, Singapore S117456, Singapore
- Institute for Digital Medicine, National University of Singapore, Singapore S117456, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore
| | - Alessandro Marinaccio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00143 Rome, Italy; (M.B.); (E.P.); (A.M.)
| | - Miriam Levi
- Epidemiology Unit, Department of Prevention, Central Tuscany Local Health Authority, 50135 Florence, Italy;
| | - Marco Morabito
- Institute of Bioeconomy, National Research Council (IBE-CNR), 50019 Florence, Italy; (A.C.); (M.M.)
- Centre of Bioclimatology, University of Florence (UNIFI), 50144 Florence, Italy
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22
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Heesakkers H, Zegers M, van Mol MMC, van den Boogaard M. The impact of the first COVID-19 surge on the mental well-being of ICU nurses: A nationwide survey study. Intensive Crit Care Nurs 2021; 65:103034. [PMID: 33863609 DOI: 10.1016/j.iccn.2021.103034] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine the impact of the first COVID-19 surge (March through June 2020) on mental well-being and associated risk factors among intensive care unit nurses. RESEARCH METHODOLOGY In September 2020, a nationwide cross-sectional survey study among Dutch intensive care nurses was carried out to measure prevalence rates of symptoms of anxiety, depression, posttraumatic stress disorder, and need for recovery (NFR), objectified by the HADS-A, HADS-D, IES-6 and NFR questionnaires, respectively. Associated risk factors were determined using multivariate logistic regression analyses. RESULTS Symptoms of anxiety, depression, and post traumatic stress disorder were reported by 27.0%, 18.6% and 22.2% of the 726 respondents, respectively. The NFR was positive, meaning not being recovered from work, in 41.7%. Working in an academic hospital, being afraid of infecting relatives and experiencing insufficient numbers of colleagues were associated with more mental symptoms, while having been on holiday was associated with reduced depression symptoms and need for recovery. CONCLUSION The first COVID-19 surge had a high impact on the mental well-being of intensive care nurses, increasing the risk for drop out and jeopardising the continuity of care. Effort should be made to optimize working conditions and decrease workload to guarantee care in the next months of the COVID-19 pandemic.
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Affiliation(s)
- Hidde Heesakkers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department Intensive Care, Nijmegen, the Netherlands.
| | - Marieke Zegers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department Intensive Care, Nijmegen, the Netherlands
| | - Margo M C van Mol
- Erasmus MC, University Medical Center Rotterdam, Department of Intensive Care Adults, the Netherlands
| | - Mark van den Boogaard
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department Intensive Care, Nijmegen, the Netherlands
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