The COVID-19 pandemic necessitates the use of personal protective equipment (PPE) by healthcare workers (HCWs), elevating heat stress risks and potentially reducing work productivity. However, limited information exists on HCWs’ experiences with PPE-related heat stress in Indonesia.
Objectives
This study examines HCWs’ experiences with PPE, their perceived knowledge and attitudes, and anticipatory practices using a case study in the Covid emergency hospital (Rumah Sakit Darurat Covid (RSDC) in Bahasa) in Jakarta, Indonesia.
Methods
Ninety-two HCWs completed self-reported surveys and 12 people participated in qualitative interviews between February and March 2022.
Results
Common heat stress symptoms were thirst, excessive sweating, and fatigue. While HCWs frequently took breaks in designated rest areas, they rarely removed PPE or hydrated regularly. Reasons included avoiding urinating, strict policies on drinking and eating, reducing the risk of disease transmission, and conserving PPE. Notably, HCWs with more positive attitudes were less likely to remove PPE during breaks. Moreover, no specific policies or infrastructure exist to assist HCWs in managing heat stress risks.
Conclusion
To mitigate or minimize heat stress, HCWs should wear comfortable, thin shirts inside PPE and receive training on how to keep hydrated when using PPE. PPE manufacturers should develop and design PPE that reduces excessive heat, since the need for comfortable PPE may increase in the future to avoid reducing HCWs’ work productivity. Finally, dedicated guidelines and supportive facilities are needed to enable healthcare workers to cope with heat stress associated with PPE usage.
VerbeekJHRajamakiBIjazS, et al.Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev2020; 4: 4.
2.
AjslevJZNMøllerJLAndersenMF, et al.The hierarchy of controls as an approach to visualize the impact of occupational safety and health coordination. Int J Environ Res Public Health2022; 19: 2731.
3.
WHO. Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19) and considerations during severe shortages. World Health Organization. 2020; December:1–7.
4.
JansonDJCliftBCDhokiaV. PPE Fit of healthcare workers during the COVID-19 pandemic. Appl Ergon2022; 99: 103610.
5.
YuanNYangWXLuJL, et al.Investigation of adverse reactions in healthcare personnel working in level 3 barrier protection PPE to treat COVID-19. Postgrad Med J2021; 97: 351–354.
6.
ZandSMotlaghMSGolmohammadiR, et al.Effects of wearing medical gowns at different temperatures on the physiological responses of female healthcare workers during the COVID-19 pandemic. Work2024; 78: 601–612.
7.
DaveySLLeeBJRobbinsT, et al.Heat stress and PPE during COVID-19: impact on healthcare workers’ performance, safety and well-being in NHS settings. J Hosp Infect2021; 108: 185–188.
8.
HoangTNAQuachHLHoangNV, et al.Assessing stress among community health workers due to COVID-19 related work: a comparative study from Vietnam. Work2025; 80: 802–813.
9.
WHO. Public health advice on preventing health effects of heat. New and updated information for different audiences. 2011:1–37.
10.
MesseriABonafedeMPietrafesaE, et al.A web survey to evaluate the thermal stress associated with personal protective equipment among healthcare workers during the COVID-19 pandemic in Italy. Int J Environ Res Public Health2021; 18: 3861.
11.
LeeJVenugopalVLathaPK, et al.Heat stress and thermal perception amongst healthcare workers during the COVID-19 pandemic in India and Singapore. Int J Environ Res Public Health2020; 17: 1–12.
12.
BongersCCWGde KorteJQZwartkruisM, et al.Heat strain and use of heat mitigation strategies among COVID-19 healthcare workers wearing personal protective equipment—A retrospective study. Int J Environ Res Public Health2022; 19: 1905.
13.
RosyantiLHadiI. Health professionals’s psychological impact in providing health care and services for COVID-19 patients. Heal Inf J Penelit2021; 12: 107–130.
14.
MerlindaEBagoesKYulianiW. Literature review: pengaruh pandemi COVID-19 terhadap kelelahan dan tingkat stres pada tenaga perawat di Indonesia. J Ilmu Keperawatan dan Kebidanan2021; 12: 270–278.
15.
YangHYChouHLLeowCHW, et al.Poor personal protective equipment practices were associated with heat-related symptoms among Asian healthcare workers: a large-scale multi-national questionnaire survey. BMC Nurs2024; 23: 145.
16.
MahengDBhattacharyaBZevenbergenC, et al.Changing urban temperature and rainfall patterns in Jakarta: a comprehensive historical analysis. Sustain2024; 16: 350.
AdliILazarusISWGPhowiraJ, et al.Knowledge, attitude, and practice related to the COVID-19 pandemic among undergraduate medical students in Indonesia: a nationwide cross-sectional study. PLoS One2022; 17: e0262827.
20.
FuadyAKhoeLCAzzahraTB, et al.Good knowledge but poor practice toward COVID-19 among Indonesian youth. Asia-Pacific J Public Heal2021; 33: 605–607.
21.
BukataITDadiLSAyanaAM, et al.Knowledge, attitudes, and practice toward prevention of COVID-19 among jimma town residents: a community-based cross-sectional study. Front Public Heal2022; 10: 822116.
22.
BraunVClarkeV. Using thematic analysis in psychology. Qual Res Psychol2006; 3: 77–101.
23.
IBM SPSS Statistics. IBM SPSS Statistics 26. IBM SPSS Statistics. 2021.
24.
ThomasJHardenA. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol2008; 8: 1–10.
25.
International Organization for Standardization. ISO 17772-1 energy performance of buildings - indoor environmental quality - part 1: Indoor environmental input parameters for the design and assessment of energy performance of buildings. 2017.
26.
WolkoffPAzumaKCarrerP. Health, work performance, and risk of infection in office-like environments: The role of indoor temperature, air humidity, and ventilation. Int J Hyg Environ Health2021; 233: 113709.
27.
PhanprasitWRittapromKDokkemS, et al.Climate warming and occupational heat and hot environment standards in Thailand. Saf Health Work2021; 12: 119–126.
28.
JegodkaYLagallyLMertesH, et al.Hot days and COVID-19: Online survey of nurses and nursing assistants to assess occupational heat stress in Germany during summer 2020. J Clim Chang Heal2021; 3: 100031.
29.
MaoYZhuYGuoZ, et al.Experimental investigation of the effects of personal protective equipment on thermal comfort in hot environments. Build Environ2022; 222: 109352.
30.
HuntATingJSchweitzerD, et al.Personal protective equipment for COVID-19 among healthcare workers in an emergency department: an exploratory survey of workload, thermal discomfort and symptoms of heat strain. EMA - Emerg Med Australas2023; 35: 483–488.
31.
ChoudhuryASinghMKhuranaDK, et al.Physiological effects of n95 ffp and ppe in healthcare workers in COVID intensive care unit: a prospective cohort study. Indian J Crit Care Med2020; 24: 1169–1173.
32.
TumramNK. Personal protective equipment and personal cooling garments to reduce heat-related stress and injuries. Med Leg J2020; 88: 43–46.
33.
HoedlMEglseerDBauerS. Associations between personal protective equipment and nursing staff stress during the COVID-19 pandemic. J Nurs Manag2021; 29: 2374–2382.
34.
RiccòMVezzosiLBalzariniF, et al.Air temperatures and occupational injuries in the agricultural settings: a report from northern Italy (Po river valley, 2013-2017). Acta Biomed2020; 91: 1–16.
35.
GreyAbou-ismailMYDiamondA, et al.Human thermal physiological response of wearing personal protective equipment: an educational building semi-open space experimental investigation. Psychiatry Res2020; 14: 293.
36.
CandidoGTortùCSeghieriC, et al.Physical and stressful psychological impacts of prolonged personal protective equipment use during the COVID-19 pandemic: a cross-sectional survey study. J Infect Public Health2023; 16: 1281–1289.
37.
HoernkeKDjellouliNAndrewsL, et al.Frontline healthcare workers’ experiences with personal protective equipment during the COVID-19 pandemic in the UK: a rapid qualitative appraisal. BMJ Open2021; 11: e046199.
38.
TabahARamananMLauplandKB, et al.Personal protective equipment and intensive care unit healthcare worker safety in the COVID-19 era (PPE-SAFE): an international survey. J Crit Care2020; 59: 70–75.
39.
DanielDKurniawanARahastriA, et al.The COVID-19 health protocol among university students : case studies in three cities in Indonesia. Int J Environ Res Public Health2022; 19: 10630.
40.
ZhangMZhouMTangF, et al.Knowledge, attitude, and practice regarding COVID-19 among healthcare workers in Henan, China. J Hosp Infect2020; 105: 183–187.
41.
DaanenHBose-O’ReillySBrearleyM, et al.COVID-19 and thermoregulation-related problems: practical recommendations. Temperature2021; 8: 1–11.
42.
García-TrabaninoRJarquínEWesselingC, et al.Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador - A cross-shift study of workers at risk of mesoamerican nephropathy. Environ Res2015; 142: 746–755.
43.
ZhaoMZhaoJYanJ, et al.The evaluation of physiological Index changes and safety work of female medical staff with different medical protection standards in the ward of COVID-19. Front Med2022; 9: 906140.
44.
JokubaitisMTimofejavaitėRBraschinskyM, et al.Risk factors for development of personal protective equipment induced headache: e-survey of medical staff in Baltic states. BMC Health Serv Res2022; 22: 1016.
45.
QuartucciCWibowoRDoV, et al.Assessment of subjective well-being of healthcare workers in response to heat and personal protective equipment under controlled conditions using a standardized protocol. J Occup Med Toxicol2024; 19: 16.
46.
FreireKGreenEKernaghanL, et al.Impact of heat and mitigation strategies on healthcare professionals: a scoping review. Public Health Nurs2025; 42: 1408–1420.
47.
SperlichBBornDPLefterMD, et al.Exercising in a hot environment: which T-shirt to wear?Wilderness Environ Med2013; 24: 211–220.
48.
XuHCaoBGaoL, et al.Personal cooling garments with phase change material packages - A critical review of challenges, solutions and recent progress. Build Environ2024; 250: 111169.
49.
KapoorABaroniaAKAzimA, et al.Breathability and safety testing of personal protective equipment: “human-comfort” factor remains undefined. Indian J Crit Care Med2021; 25: 12–15.
50.
DanielDPrawiraJPamudjiT, et al.A system dynamics model of the community-based rural drinking water supply program (PAMSIMAS) in Indonesia. Water (Basel)2021; 13: 507.
51.
SammutDRGrisctiDONormanPIJ. Strategies to improve response rates to web surveys: a literature review. Int J Nurs Stud2021; 123: 104058.
52.
PurwandariRDanielDHafidzF. Analysis of water, sanitation, and hygiene facilities using the WASH-FIT approach and its relation to patient satisfaction and maternal mortality at hospitals in Indonesia. Front Public Heal2024; 12.
53.
RileyRDSnellKIEEnsorJ, et al.Minimum sample size for developing a multivariable prediction model: PART II - binary and time-to-event outcomes. Stat Med2019; 38: 1276–1296.
54.
VecchioRCasoGCembaloL, et al.Is respondents’ inattention in online surveys a major issue for research?Econ Agro-Alimentare2020; 22: 1–18.
