PPE-related adverse effects compromise HCWs’ work quality

Healthcare workers (HCW) commonly report side effects associated with the use of personal protective equipment (PPE), according to a recent Singapore study. In turn, HCWs say that these side effects negatively impact their work.

“Findings will inform the development of targeted interventions to improve infection control practices and better support for HCWs providing care and treatment during the COVID-19 pandemic,” the researchers said. “Improvements in PPE design are needed to increase HCWs' adherence to PPE usage and minimize the potential for exposure to COVID-19 infection.”

A total of 592 HCWs participated in the present descriptive cross-sectional study, all of whom were recruited from an acute care hospital. Participants were asked to complete an online survey that assessed PPE usage frequencies, associated side effects, and resulting interference with patient care, as well as perceptions of access to and efficacy of PPEs, and adequacy of the training HCWs received.

Overall, HCWs reported using PPEs for a mean of 6.14 hours per day. The vast majority (88 percent) said they used N95 masks, while 70.3 percent wore surgical masks. Face shields (67.4 percent) and goggles (52.7 percent) were other commonly reported PPEs. [J Adv Nurs 2022;doi:10.1111/jan.15164]

More than half (53.8 percent) of respondents said they experienced PPE-related side effects. Most (88.4 percent) were nurses or other HCWs working in high-areas, such as the emergency department (39.5 percent), acute (22.3 percent) and nonacute (23.8 percent) respiratory wards, and COVID-19 isolation wards (13.8 percent).

Logistic regression analysis further confirmed that working in high-risk wards were at a significantly higher risk of PPE-associated side effects (odds ratio [OR], 3.12, 95 percent confidence interval [CI], 2.17–4.60; p<0.001), as were women (OR, 2.10, 95 percent CI, 1.29–3.42; p=0.003). In contrast, respondents aged ≥51 years (OR, 0.40, 95 percent CI, 0.22–0.72; p=0.002) and those with pre-existing skin conditions (OR, 0.33, 95 percent CI, 0.23–0.47; p<0.001) were less likely to see such side effects.

In terms of symptoms, N95-associated side effects were most reported, including mask-related pressure injuries (45.6 percent), acne (40.4 percent), and burning/pain (24.5 percent). Pressure injuries from goggles were also common (32.3 percent).

In turn, the survey found that PPE-related side effects negatively impacted the work of nearly a third of HCWs (31.3 percent; n=100) due to pain, discomfort, itch, and the frequent need to readjust PPEs. Moreover, a fifth (19.6 percent) agreed that PPEs interfered with their ability to provide care to their patients.

“The impact of PPE-related adverse effects on our HCWs must not be underestimated, even during times of pandemic. Prevention and management of these adverse effects is vital to preserve the integrity of PPE and minimize the risk of COVID-19 transmission,” the researchers said.

“Even though climate factors, including temperature and humidity, cannot be controlled, other approaches can be undertaken to improve the experience of HCWs particularly those using full PPE in high-risk work areas,” they added.