Zhu Yongcheng, Qiao Sichen, Wu Weiming, Li Yanling, Jian Huilin, Lin Shaopeng, Tang Tianwei, Zheng Zhimin, Mao Yudong, Chen Xiaohui, Fang Zhaosong
The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
School of Civil Engineering, Guangzhou University, Guangzhou, China.
Case Stud Therm Eng. 2022 Jun;34:101971. doi: 10.1016/j.csite.2022.101971. Epub 2022 Apr 6.
In contrast to the previous COVID-19 pandemic, most frontline healthcare workers (HCWs) worked on residents' nucleic acid tests in outdoor environments, instead of taking care of COVID-19 patients in hospitals during the hot summer of 2021. Therefore, it is necessary to investigate the prevalence and characteristics of thermal discomfort caused by personal protective equipment (PPE).
A cross-sectional survey was conducted online at hospitals from 11 administrative regions of Guangzhou for the assessment of thermal discomfort among HCWs from June 12-16, 2021. Univariate and logistic regression analyses were used to explore the risk factors associated with thermal discomfort.
A total of 3658 valid responses were collected. The thermal discomfort and humid discomfort levels increased from 2.91 ± 1.19 to 3.61 ± 0.72 and from 0.98 ± 1.36 to 3.06 ± 1.1 after wearing PPE, respectively (p < 0.01). Feelings of being "very hot" and "uncomfortably humid" were the most influenced by wearing PPE, increasing from 31% to 69.1% and from 9.1% to 45.7%, respectively. There were significant increases in the thermal discomfort level (3.75 ± 0.57 vs. 3.33 ± 0.89, p < 0.01) and the humid discomfort level (3.33 ± 0.95 vs. 2.54 ± 1.19, p < 0.01) between the comfortable group and uncomfortable group, accompanied by similar patterns in the feelings of being "very hot" and "uncomfortably humid." For general thermal-related symptoms, the most common new-onset symptom was profuse sweating (80%) followed by labored breathing (55.2%) and excessive dehydration (46.8%), while facial swelling (74%) was associated with local thermal-related symptoms, followed by hand maceration erosion (56.7%) and visual impairment (49.3%). In the multivariate analysis, the apparent temperature of the environment (≥35 °C), working in negative-pressure ambulances and outdoors, continuing to wear PPE for 1-3 days during this period, being aged >40 years, and previous experiences fighting the pandemic were independently associated with thermal discomfort (p < 0.01). Immediately after PPE removal, 32.3% of respondents considered drinking ice water/another drink, followed by 25% shortening the duration of wearing PPE and 19.1% going to the toilet. A large proportion of the participants looked forward to modifications to the material of the suit (72.9%) and mask (53.4%) for heat dissipation and dehumidification, as well as anti-fogging goggles (60.2%), adding hydration equipment to PPE (53.4%), and using soft materials to reduce pressure (40%).
Thermal discomfort is common and degrades health physiology related to PPE in summer environments. This suggests that modifications to the current working practices are urgently required to improve the resilience of HCWs and enhance their services during pandemics.
与之前的新冠疫情不同，在2021年炎热的夏季，大多数一线医护人员在户外环境中进行居民核酸检测工作，而不是在医院照料新冠患者。因此，有必要调查个人防护装备（PPE）引起的热不适的患病率及特征。
2021年6月12日至16日，在广州11个行政区的医院开展了一项在线横断面调查，以评估医护人员的热不适情况。采用单因素和逻辑回归分析来探究与热不适相关的危险因素。
共收集到3658份有效回复。佩戴PPE后，热不适和湿不适水平分别从2.91±1.19升至3.61±0.72，以及从0.98±1.36升至3.06±1.1（p<0.01）。“非常热”和“湿得难受”的感觉受佩戴PPE的影响最大，分别从31%增至69.1%和从9.1%增至45.7%。舒适组和不舒适组之间的热不适水平（3.75±0.57对3.33±0.89，p<0.01）和湿不适水平（3.33±0.95对2.54±1.19，p<0.01）显著升高，“非常热”和“湿得难受”的感觉也呈现类似模式。对于一般的热相关症状，最常见的新发症状是大量出汗（80%），其次是呼吸困难（55.2%）和过度脱水（46.8%），而面部肿胀（74%）与局部热相关症状有关，其次是手部浸渍糜烂（56.7%）和视力受损（49.3%）。在多因素分析中，环境表观温度（≥35°C）、在负压救护车和户外工作、在此期间连续佩戴PPE 1 - 3天、年龄>40岁以及之前的抗疫经历与热不适独立相关（p<0.01）。摘下PPE后，32.3%的受访者考虑喝冰水/其他饮品，其次是25%的人缩短佩戴PPE的时长，19.1%的人去上厕所。很大一部分参与者期待改进防护服（72.9%）和口罩（53.4%）的材料以散热除湿，以及改进防雾护目镜（60.2%），在PPE上增加补水设备（53.4%），并使用柔软材料减轻压力（40%）。
热不适很常见，且会在夏季环境中损害与PPE相关的健康生理状况。这表明迫切需要对当前的工作方式进行改进，以提高医护人员的适应能力，并在疫情期间提升他们的服务水平。
