Infographic. Cooling strategies to attenuate PPE-induced heat strain during the COVID-19 pandemic

Abstract

COVID-19 healthcare personnel (HCP) use personal protective equipment (PPE; ie, isolation gowns, eye protection, facemasks and respirators) to safely perform their medical duties. However, PPE creates a microenvironment around the skin due to a higher thermal resistance and lower water vapour permeability of the materials being used compared with the normal clothing ensemble of HCP.1 Consequently, heat loss capacity via the skin surface is greatly reduced. The metabolic energy expenditure from regular working activities could, therefore, not be completely lost to the surrounding environment, leading to heat strain, thermal discomfort, excessive sweating, faster dehydration and an increased cardiovascular strain. To accommodate heat loss, blood redistribution from central organs and skeletal muscle to the skin occurs, which will further exacerbate the physiological strain, ultimately leading to shorter work tolerance times and a reduced physical and cognitive performance. The most common recommendation for working in PPE is to adjust the work/rest schedule and incorporate more and longer breaks in order to alleviate heat strain. However, this recommendation is not always feasible in clinical settings as hospitals are often understaffed during the COVID-19 pandemic.