Occupational heat stress in nurses working in hot environments and wearing personal protective equipment: mechanisms, health and safety implications, and prevention

Climate change is increasing the frequency, intensity, and duration of extreme heat, while infection prevention and other clinical demands require many nurses to work in personal protective equipment (PPE). Hot environments and PPE use can coexist in emergency departments, intensive care units, infectious disease wards, operating rooms, prehospital services, and other settings in which workload, restricted recovery opportunities, and limited access to hydration may compound thermal strain. This narrative review integrates current evidence on the pathways through which environmental heat, metabolic workload, and PPE-related resistance to heat loss may affect nurses and other healthcare workers. An initial set of 31 references identified by the authors was updated through a PubMed search conducted on 2 September 2026 (three queries covering January 2024 to September 2026, plus one calibration query without date limits). For each cited study, the population, design, main findings, and directness to nurses were extracted, and the evidence was synthesized narratively across four domains: pathways, health and safety implications, risk assessment and monitoring, and prevention. Available studies, mostly of mixed healthcare-worker populations, consistently describe thermal discomfort, sweating, thirst, fatigue, headache, dizziness, and impaired well-being among PPE-exposed healthcare workers; however, nurse-specific longitudinal evidence and direct evidence linking heat strain to occupational injuries or patient-safety events remain limited. Effective prevention therefore requires more than individual coping. Healthcare facilities should combine environmental surveillance, task and PPE-sensitive risk assessment, accessible hydration and cooled recovery areas, work-rest and staffing arrangements, risk-appropriate PPE, personal cooling where feasible, symptom reporting, and emergency response. Future research should prioritize nurse-specific prospective cohorts, standardized exposure and outcome measures that include nurses’ well-being and occupational safety, field-based intervention studies, and implementation outcomes across diverse climates and clinical settings. Integrating occupational heat protection into climate-resilient health-system planning may protect both the nursing workforce and continuity of care.