The Physiological Effects of Prolonged PPE Use During Long Shifts

NIOSH and the CDC discuss the burden many healthcare workers face with prolonged use of PPE during long shifts. If your workers are required to wear PPE for long periods of time, be aware of these side effects and tips on how to mitigate harm.

Healthcare workers and first responders are expected to work long shifts in physically demanding environments—all with increased exposure to COVID-19 and with PPE. During this public health emergency, these workers are crucial to protecting us, but their PPE is crucial to protecting them. Unfortunately, wearing PPE can have negative effects on the worker.

A healthcare worker’s PPE might include N95 filtering facepiece respirators (FFRs) elastomeric half-make respirators or powered air-supplied respirators (PAPRs). They also wear gloves, surgical masks, face shields and gowns.

Wearing PPE for long periods of time can have physiological burdens on the worker. It is important to understand the effects of the equipment and learn how to lighten that burden on the worker.

Many factors can exacerbate the PPE burden, including obesity, underlying respiratory conditions (asthma, allergies, COPD, etc.) and smoking. Healthcare workers and first responders should be given regular opportunities to take breaks and report symptoms related to their PPE.

For example, wearing an FFR for a long period of time may cause dizziness (as well as other symptoms), which could affect worker, workplace and patient safety. Dizziness can be caused by dehydration, hyperventilation (gasping for breath), elevated carbon dioxide levels in the blood, low blood sugar, anxiety and a number of other factors.

Different respirators have different, potential physiological impacts. You should be aware of each facepiece’s potential symptoms of use:

Filtering Facepiece Respirators (FFR)

Hyperventilation is a common side effect of wearing an N95 FFR. When healthcare workers are working longer hours without a break while continuously wearing an N95 FFR, carbon dioxide levels may accumulate in the respiratory and cause the following effects on the wearer:

  • Headache;
  • Increased pressure inside the skull;
  • Nervous system changes (e.g., increased pain threshold, reduction in cognition – altered judgement, decreased situational awareness, difficulty coordinating sensory or cognitive, abilities and motor activity, decreased visual acuity, widespread activation of the sympathetic nervous system that can oppose the direct effects of CO2 on the heart and blood vessels);
  • Increased breathing frequency;
  • Increased “work of breathing”, which is result of breathing through a filter medium;
  • Cardiovascular effects (e.g., diminished cardiac contractility, vasodilation of peripheral blood vessels);
  • Reduced tolerance to lighter workloads.

Elastomeric Respirators (EHMRs)

The effects of wearing elastomeric respirators are similar to those of wearing FFRs for long periods of time. EHMRs are a reusable type of respirator with a silicone facepiece and replaceable filter cartridges. Because they are reusable, EHMRs are a recommended alternative to the disposable N95 FFRs.

However, the most common physiological burden on the wearer with EHMRs is anxiety. The increased breathing resistances found in EHMRs can result in a decreased frequency of breathing and an increase in tidal volume (the air displaced between normal inhalation and exhalation).

Powered Air Purifying Respirators (PAPRs)

PAPRs are another alternative to N95 FFRs. The physiological benefit of PAPRs is that they have a fan that blows fresh air through the filter, and there is not much breathing resistance with this piece. However, effects of wearing the PAPRs (especially listening to the constant noise of the motor) include headache, distraction, anxiety and difficulty communicating with others.

Healthcare worker and first responder health is crucial to surviving this pandemic—and any other medical or health crisis. Remind your workers to:

  • Take scheduled breaks and remove PPE when safe
  • Hydrate and eat well
  • Implement and use policies for overall wellbeing including check ins, assessment of symptoms and encouragement to report symptoms.

For more information and references, refer to the NIOSH and CDC page on these respirators.

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