Long-term effects of use of personal protective equipment on cognitive functions of healthcare workers: A case-control study

Objectives: The COVID-19 pandemic affected 216 countries, leading to high death rates worldwide. Front-line healthcare workers (HCWs) were at greater risk of contracting COVID-19 than the general population. Healthcare systems and HCWs must provide proper case management while ensuring their safety. For HCWs, this involves using personal protective equipment (PPE) while treating suspected cases. During their duties in COVID-19 wards, HCWs must wear PPE for extended periods, sometimes more than 6–8 h, leading to problems such as headaches, dizziness, anxiety, lack of attention, visual and hearing problems, dyspnea, hypoxia, and suffocation. The objective of this study was to assess the cognitive functions of HCWs working in PPE for long durations. The secondary objective was to investigate the association between long-term PPE use and cognitive functions in HCWs. Materials and Methods: A total of 128 HCWs were divided into four groups based on the duration of PPE use: Group 1 (short duration group: Less than 6 h/day), Group 2 (moderate duration group: More than 6 h but <8 h/day), Group 3 (long duration group: More than 8 h/day), and a control group with no PPE use. After obtaining valid consent, the selected participants underwent cognitive assessments following their COVID-19 duty. The cognitive parameters assessed included attention (auditory and visual reaction times) and executive functions (Stroop test and Eriksen flanker test [EFT]). Results: The results showed a positive correlation between the duration of PPE use and cognitive function scores in the attention and executive function domains, specifically in visual and auditory reaction times, Stroop test performance, and EFT results. Conclusion: The study concluded that HCWs with more than 8 h of continuous PPE duty were more vulnerable to adverse neurocognitive effects compared to HCWs with 6–8 h or <6 h of PPE use. These findings can serve as a basis for developing better protocols for PPE usage among HCWs and implementing precautionary measures before PPE duty. Regular screening of HCWs for potential cognitive decline should also be promoted.