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What were the effects of prolonged personal protective equipment use during the COVID-19 pandemic?

In a recent study posted to Preprints with The Lancet*, researchers explored the physical and stress-related psychological effects of the coronavirus disease 2019 (COVID-19) pandemic on healthcare workers.

Study: Physical and Stressful Psychological Impacts of COVID-19 on Healthcare Workers Due to Prolonged Personal Protective Equipment Use: A Cross-Sectional Survey Study. Image Credit: Cryptographer/Shutterstock


Research has indicated that the COVID-19 pandemic has resulted in major unfavorable influences on healthcare workers (HCWs), necessitating significant modifications to the schedules of global health systems and HCWs. Personal protective equipment (PPE) kits consisting of a respirator mask, gloves, and gown, are required to be worn at all times by HCWs to protect themselves and their patients from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The obligation to wear PPE was a vital precaution against the viral spread; however, wearing PPE for extended periods of time is extremely uncomfortable. Changes in HCWs' work habits have not been researched regarding their long-term mental and physical well-being.

About the study

In the present study, researchers determined the extent of mental health and physical consequences resulting from prolonged usage of PPE among HCWs who treated COVID-19 patients.

The team performed a prospective and cross-sectional analysis utilizing a validated online survey distributed to a cohort of risk managers. The survey was conducted between 1 February and 31 March 2022, when the fourth wave of COVID-19 infections was prevalent in Italy. The researchers first collected demographic and work-related responses from the participants, which included age, sex, work placement, clinical area of reference, professional role, and questions related to working in an intensive care unit (ICU) ward, a ward having COVID-19 patients, and the level of PPE equipment used concerning the perceived risk of exposure to the HCW.

The team then assessed the physical discomforts of the participants, and HCWs were asked if they experienced physical discomforts that were potentially due to prolonged PPE use. Additionally, the study focused on the respondents' psychological symptoms. The HCWs were requested to provide information regarding their psychological health. In the analysis, the following psychological outcomes were considered: (1) stress and anxiety as measured by the Stress and Anxiety to Viral Epidemics (SAVE)-19 scale, ii) insomnia as measured by the Insomnia Severity Index (ISI) scale, and iii) perceived level of resilience as measured by the Resilience Scale (RS)-14 scale.


The sample cohort comprised a total of 727 responses. The majority of respondents were female (72%), between the ages of 35 and 55 years (51%), and included registered nurses (45%), physicians (25%), students/researchers (9%), social HCWs (6%), technicians (6%), and others (8%). Almost 17% of participants reported working in ICU wards, 32% in standard COVID-19 wards, and 43% using PPE most frequently for the medium-risk category. The responders reported scores of 23% for stress and 33% for anxiety. Additionally, 43% of the group found moderate to severe insomnia, and moderate to very low resilience was observed in 67%.

The adjusted odds ratios revealed that being aged over 55 years reduced the chance of stress in comparison to being aged less than 35 years. Furthermore, HCWs who were aged between 35 and 55 years and more than 55 years had higher odds of experiencing insomnia as compared to those aged less than 35 years. Women reported a lesser likelihood of displaying resilience than male HCWs.

University hospital employees reported a lower chance of experiencing anxiety than their community hospital counterparts. Insomnia was more prevalent among social workers than in physicians. HCWs experienced the following bodily discomforts: trouble communicating with coworkers or patients at work (62%), thirst (54%), retroauricular pain (58%), physical tiredness (50%), thermal stress (44%), shortness of breath (39%), nausea (17%), micturition urge (14%) and vertigo (11%).

Female HCWs had a greater likelihood of experiencing retroauricular pain, discomfort at work, thirst, and physical weariness, while male HCWs reported a lesser likelihood of urinary discomfort. Compared to physicians, nurses were more likely to report vertigo, nausea, dyspnea, thirst, micturition urge, and physical exhaustion. The likelihood of reporting discomforts like nausea, micturition urge, thirst, retroauricular pain, physical weariness, discomforts at work, and thermal stress was lower among HCWs who did not work in COVID-19 patient wards.

Being aged over 35 years, female, and working as a social worker, nurse, technician, or other HCW raised the likelihood of experiencing an increased amount of bodily discomfort. In addition, not working on a COVID-19 ward and wearing PPE at low-to-moderate risk levels of COVID-19 exposure resulted in a remarkable decrease in the proportion of overall physical discomforts experienced by HCWs.


The study findings highlighted novel and important understanding regarding the psychological troubles and physical discomforts associated with prolonged usage of PPE throughout the COVID-19 epidemic. Over time, the prolonged and constant use of PPE may have negatively affected the physical and mental well-being of HCWs. The results justified frequent monitoring and specialized treatments to prevent adverse outcomes related to the mental health of HCWs over the long term. Implementing clinical standards for mental health linked to sleep, resiliency, and anxiety will improve job resilience as well as the well-being of health professionals.

*Important notice

Preprints with The Lancet publish preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
  • Candido, Giuseppe and Tortù, Costanza and Seghieri, Chiara and Tartaglia, Riccardo and Baglioni, Chiara and Citti, Paolo and Raciti, Ida and La Regina, Micaela and Simonini, Silvia and Urbani, Moira and Parretti, Chiara and Barach, Paul. (2023). Physical and Stressful Psychological Impacts of COVID-19 on Healthcare Workers Due to Prolonged Personal Protective Equipment Use: A Cross-Sectional Survey Study. Preprints with The Lancet. Available at SSRN: https://ssrn.com/abstract=4339360 doi: http://dx.doi.org/10.2139/ssrn.4339360 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4339360

Posted in: Medical Science News | Medical Research News | Disease/Infection News

Tags: Anxiety, Coronavirus, Coronavirus Disease COVID-19, covid-19, Dyspnea, Exhaustion, Global Health, Health Systems, Healthcare, Hospital, Insomnia, Intensive Care, Mental Health, Nausea, Pain, Pandemic, Personal Protective Equipment, PPE, Research, Respiratory, SARS, SARS-CoV-2, Severe Acute Respiratory, Severe Acute Respiratory Syndrome, Sleep, Stress, students, Syndrome, Tiredness, Vertigo

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Written by

Bhavana Kunkalikar

Bhavana Kunkalikar is a medical writer based in Goa, India. Her academic background is in Pharmaceutical sciences and she holds a Bachelor's degree in Pharmacy. Her educational background allowed her to foster an interest in anatomical and physiological sciences. Her college project work based on ‘The manifestations and causes of sickle cell anemia’ formed the stepping stone to a life-long fascination with human pathophysiology.

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  • Posted on February 2, 2023