الفهرس 
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Abstract
COVID-19 outbreak has brought into intensive focus theparamount importance of personal protective equipment to preventthe widespread of this infectious disease. However,although essential to work comfortably and safely, PPE have demonstrated to bepotentially harmful due to their persistant and repetitive donning.Implementation and administration of PPE fitting and high quality materials, adherenc to preventive stratigies along with reduction of wearing time, avoiding long time, are crucial to ensure safe and secure condition of working to critical care nurses, leading to better working atmosphere in isolation Intensive Care Units during current pandemic.
It was determined that all of the critical care nurses who participated in the study, reported various effects encountered in both aspects physically and psychologically. The majority of the negative physical effects that the critical care nurses encountered in this study were: general fatigue and discomfort (heat stress and excessive sweating); a negative impact on professional and clinical performances (work tasks take longer time); skin problems (face pressure from masks); an impact on basic physiological needs (feeling thirsty); and, finally, an adverse effect on using senses (vision problems due to fogging).
In addition to psychological side effects, a broad spectrum of the studied critical care nurses experienced stress, anxiety, and depression as a result of wearing personal protective equipment. The study also reveals some demographic characteristics of the critical care nurses under study that may serve as predictors of the unfavourable outcomes. These characteristics include the existence of bronchial asthma, a history of chronic illness, prior experience working in an isolation ward, staff members’ assigned patient numbers, and PPE training numbers.
Material &Method
Materials
Research Design:
A descriptive research design was used to identify the adverse effects associated with personal protective equipment (PPE) among critical care nurses during the COVID-19 outbreak.
Setting:
This study was performed in the Alexandria New University Hospital (ANUH) that includes 3 isolation ICUs with a bed capacity of 24 beds, which is affiliated to the Ministry of Higher Education. El Agamy General Hospital that includes 4 ICUs with a bed capacity of 52 beds. Alexandria Fever Hospital that includes 4 ICUs with a bed capacity of 26 beds. Kom El-Shoqafa Chest Hospital that includes 2 ICUs with a bed capacity of 24 beds. In addition to AL Mamoura Chest Hospital, that includes 3 ICUs with a bed capacity of 25 beds. These previous four hospitals are affiliated to the .Ministry of Health. All the previously mentioned hospitals are dedicated to care for COVID-19 patients.
Subjects:
A convenience sample of all the nurses working in the intensive care units of the previously mentioned ICUs isolation and providing direct care for COVID-19 patients constituted the subjects for this study (170 nurses) included in this study. The numbers of the participated nurses were as f.ollows: 28 nurses from Alexandria New University Hospital (ANUH), 40 nurses from El Agamy General Hospital, 34 nurses from Alexandria Fever Hospital, 28 nurse from Kom El-Shoqafa Chest Hospital, and 40 nurses from Al Mamoura Chest Hospital. Data were collected by the researcher over a period oftwo months (from start of January to end of February 2022).
Tool:
This study used a tool called ”Nurses’ Personal Protective Equipment Related Adverse Effects Assessment” to assess the impact of PPE on nurses.
The tool consisted of three parts: ”Nurses’ sociodemographic and professional characteristics,” ”Physical Adverse Effects Associated with Using Personal Protective Equipment,” and ”Depression Anxiety Stress Scales (DASS-21).” The tool was developed by the researcher except the third part, it was adopted. The first part aimed to identify nurses’ demographic and job-related data, such as age, sex, marital status, and chronic illness. The se.cond part assessed the physical adverse effects of PPE on different body systems, such as senses, respiratory system, skin, basic physiological needs, and mental performance. The third part used the Depression Anxiety Stress Scales (DASS-21), a tool developed by Lovibond et al., 1995, to assess psychological adverse effects such as depression, anxiety, and stress. The scores for each subscale ranged from 0 to 21, with higher scores indicating greater depression, anxiety, and stress levels.
Data were collected as follows:
The study involved ICU nurses providing direct patient care for critically ill COVID-19 patients. Data was collected through interviews, assessing demographic and job-related data. The researcher asked about physical and ps.ychological adverse effects of using PPE, including depression, anxiety, and stress. The scores were calculated based on subject responses.
Resuts
Regarding the physiological adverse effects, the study reveals that wearing PPE negatively impacts critical care nurses’ senses, with vision being the most affected. Other senses include communication, hearing, recognizing, and touch. Persistent discomfort and fatigue are common, with excessive sweating, heat stress, dizziness, headaches, and movement changes. Most nurses report poorly fitted and sized PPE, while the least reported discomfort is nausea. The majority of nurses experience a negative respiratory effects, such as chest tightness, dyspnea, thirst, and hunger. Skin problems are common, with pressure on the face causing itching and sores. Professional and clinical performance is also affected, with work tasks taking longer while wearing PPE. Over one-third of nurses experience difficulty thinking clearly while wearing PPE. Overall, PPE can negatively impact nurses’ overall well-being an.d performance.
Ragarding the psychological adverse effects, shows the prevalence of depression, anxiety, and stress symptoms in the studied critical care nurses. The critical care nurses analysed, 136 (80%) reported having depression, 154 (90.6%) had anxiety, and 120 (70.6%) had stress. The study’s sample of critical care nurses revealed that their mean percentage of stress was 50.33%, their mean percentage of anxiety was 47.24%, and their mean percentage of depression was 44.19%.
The study explores the association between physical adverse effects of using PPE and the characteristics of the study sample. The results show that 49.50% of the variability in the effects is explained by the critical care nurse’s cha.racteristics, with two variables being predictors of factors associated with physical adverse effects. Three variables were found to be predictors of psychological adverse effects: the presence of previous work in isolation ICU, the number of patients assigned to staff, and the frequency of training about PPE. Nearly 86.9% of the variability in the effects is explained by the critical care nurse’s characteristics, with four variables being predictors of depression: marital status, history of chronic disease, presence of respiratory disease, experience in managing infectious diseases, previous work in isolation ICU, and type of PPE used. Finally, over 81.2% of the variability in the effects is explained by the critical care nurse’s characteristics.
Conclusion
It can be concluded that the critical care nurses have both physicaly and psychollogicaly adverse effects. The study found that critical care nurses experienced fatigue, discomfort, and skin problems due to wearing personal protective equipment. These effects negatively impacted their professional and clinical performance, basic physiological needs, and senses. Psychological side effects included stress, anxiety, and depression. Demographic characteristics such as bronchial asthma, chronic illness, isolation ward experience, and PPE training numbers may predict unfavorable outcomes.
Based on findings of this study, it is recommended:
- Work shifts should be adjusted for ICUs nurses to ensure working with PPE have plenty of rest periods to decrease adverse effects.
- Applaing and ensuring the schadualling of nursing hours with respecting their preference, andadequate ICU nurse to patient ratio.
- Applaing medical and psychological assessment of ICUs nurses before .working in ICUs isolations.
- ICUs nurse should be assessed with psychologist for early psychological assessment and intervention.
- Powered respirators using inclusion to facilitate air blowing inside the mask.
- Education enhancement and training including PPE training and occupational hazards exposure and management.
- Periodic professional training on PPE best practice of donning and doffing techniques.
- Ensouring adequate PPE supplies with high quality materials, and should be designed in amanner that it dose not cause discomfort during its use, or interfering with patient, collagues, and ICU nurses interaction
- Developing workplace policies and procedures that focus on maintaining safty working environment for critical care nurses in isolation ICUs
- Developing a reporting systems for physical and psychological effects occurance as effect of PPE during working in isolation ICUs.
- Ensuring resources managements includes stock managements, availability of different sizes, and recommended shapes of PPE are available.
- Future research should be conducted to identify the best practice and performances that applied for prevention of physical and psychological .PPE effects on ICUs nurses.
- Further researches should be applied to provide management strategies against physical andpsychological adverse effects
- Replicating this study on alarge size selected from different Ministry of Health hospitals and General hospitals.