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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 17  |  Issue : 3  |  Page : 99-102

Adverse effects of using masks, sanitizer, and gloves among healthcare workers in a tertiary care center during the COVID-19 pandemic: A questionnaire-based study


Amrita Institute of Medical Sciences, Kochi, Kerala, India

Date of Submission05-Jul-2021
Date of Acceptance25-Aug-2021
Date of Web Publication25-Nov-2021

Correspondence Address:
Ms. Namratha K Narayanan
Amrita Institute of Medical Sciences, Kochi, Kerala.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AMJM.AMJM_30_21

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  Abstract 

Background and Objectives: The ongoing coronavirus pandemic was first identified in Wuhan, Hubei, China on December 2019. India reported its first case on January 30, 2020 in Kerala. As COVID-19 is mostly a droplet infection, it necessitates the use of masks, gloves, and sanitizers for containing its spread. This study aims to understand the potential adverse effects of constant use of masks, gloves, and sanitizers among healthcare workers (HCWs). Materials and Methods: This is a cross-sectional study conducted among 165 HCWs from a single tertiary healthcare center in Kerala using a validated questionnaire. Data were analyzed using Microsoft Excel and SPSS version 20. Results: Among 165 participants, the most common adverse effects due to mask usage were dermatological in nature (57%). With regard to sanitizers, majority experienced dryness of hands (53.3%). Gloves were well tolerated with 62% of the participants reporting no adverse effects. Conclusion: Prolonged use of mask, sanitizer, and gloves has caused adverse effects in majority of HCWs surveyed. As the pandemic still stands as a crisis, it is necessary to identify solutions to manage these adverse effects for the betterment of the health of our HCWs.

Keywords: Adverse effects, COVID-19, gloves, masks, sanitizer


How to cite this article:
Anand A, Narayanan NK, Pradeep M, Shanavas N, Anil A, Bhavani N, Nair AS. Adverse effects of using masks, sanitizer, and gloves among healthcare workers in a tertiary care center during the COVID-19 pandemic: A questionnaire-based study. Amrita J Med 2021;17:99-102

How to cite this URL:
Anand A, Narayanan NK, Pradeep M, Shanavas N, Anil A, Bhavani N, Nair AS. Adverse effects of using masks, sanitizer, and gloves among healthcare workers in a tertiary care center during the COVID-19 pandemic: A questionnaire-based study. Amrita J Med [serial online] 2021 [cited 2021 Dec 9];17:99-102. Available from: https://www.ajmonline.org.in/text.asp?2021/17/3/99/331115




  Introduction Top


The novel coronavirus SARS-CoV2 was first identified in December 2019 in Wuhan, Hubei, China and has resulted in the ongoing coronavirus pandemic. On February 11, 2020, the World Health Organization (WHO) officially named the disease caused by 2019-nCoV, coronavirus disease 2019 (COVID-19).[1] In Kerala, the first case was reported in Thrissur on 30th of January 2020. As of now, the world tally of infection and death stands at 17 crores and 35 lakhs, respectively, whereas the corresponding figures in India are 3 crores and 3.2 lakhs. The transmission of this disease can occur via direct contact, droplet infections, contaminated fomite, and probably through air also. Treatment strategies are still evolving, and no specific drug against SARS-CoV2 has been discovered so far.[2] Hence, it is important to break the chain of transmission of corona virus by isolation of contacts and strict infection control methods. Using masks helps to filter respiratory droplets of different sizes and hence acts as a mechanical barrier against this droplet infection. Hand sanitizers are liquids having viricidal activity, the main target of which is the viral envelope. Defective envelope formation prevents viral assembly.[3] Use of hand gloves is a time-tested infection control strategy. Thus, the use of personal protective measures such as mask, gloves, and hand sanitizers still remains the most effective way of preventing transmission of the virus. These are advised to be used by everyone in the community. Healthcare workers (HCWs) are forced to use these protective measures constantly. Wearing mask for long hours has been known to cause a wide range of side effects and a decrease in the efficiency of work along with various health issues.[4] There has been limited studies from our part of the world on the incidence of side effects of prolonged use of masks, gloves, and sanitizers among HCWs. Kerala’s hot and humid climate is expected to produce more such side effects. Hence, this study was planned to identify the ill effects of constant and prolonged use of gloves, masks, and hand sanitizers among HCWs.


  Materials and Methods Top


A cross-sectional study was conducted among HCWs from a single tertiary healthcare center in Kerala. The study was approved by the Institutional Ethics Committee. HCWs who used masks, gloves, and sanitizers often, and were on duty for at least 3 months during the pandemic, were included in the study. Those having significant medical illnesses in the past were excluded.

An online form containing a validated questionnaire was created and validated by five experts. Cronbach’s alpha score is 0.8. It was sent through email and WhatsApp to the participants. The questionnaire consisted of 22 questions divided into four subsections: personal questions and questions based on masks, sanitizers, and gloves. Personal questions included questions about name, age, sex, and profession. Mask-based questions included the type of masks used, duration of usage, adverse effects experienced, sites affected, and measures taken to get relief from the adverse effects. The questions that applied to use of hand sanitizer were based on the number of times it was used in a day, symptoms experienced, and the measures taken to get relief from the symptoms. Questions that assessed the harmful effects of gloves were based on the type of gloves used, average duration of continuous use, adverse reactions experienced on glove usage, previous history of latex allergy, duration of use after which the symptoms appeared, and measures taken to get relief from the symptoms.

Statistics

Based on the proportion of rashes on face experienced by health workers (39%) observed in the study “Effects of prolonged use of facemask on healthcare workers in tertiary care hospital during COVID-19 pandemic” conducted by Purushothaman in SRM Medical College Hospital, and with 20% allowable error and 95% confidence, the minimum sample size came to 151 for this study.

The data were tabulated in Excel sheets, and percentage prevalence of occurrence of adverse effects due to the use of masks, gloves, and sanitizers among health workers was computed. Statistical analysis was done using SPSS version 20. Independent T-test was done to find the effect of gender and analysis of variance to find the effect of different age groups on the outcomes. P-value less than 0.05 was taken as significant.


  Results Top


About 165 HCWs who satisfied the inclusion criteria were enrolled in the study. Out of 165 responses, majority of the respondents were from the age group of 18 to 27 (59.4%) and mean age was 28, of which 64.2% were females and 35.2% were males. Among them, 49.7% were doctors, 18.8% were nurses, 23.6% were paramedical personnel, and the remaining 7.9% were people who have other occupation in the hospital.

Majority of the respondents used N95 mask (83.6%) and for an average duration of 6–12 h. Adverse skin effects were experienced by 57% of the respondents and 63% had other adverse symptoms. Most of the respondents developed adverse effects after using masks for more than 6 h (35.4%). About 35.8% of them experienced these symptoms for less than 1 h. To get relief from the symptoms, majority of the respondents (58.2%) sought to remove masks for a while. Major side effects of usage of masks and the areas affected most are given in [Table 1].
Table 1: Major side effects of mask usage and most commonly affected areas

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Of the 165 respondents, the majority used hand sanitizer every half hourly (28.5%) and hourly (20.6%). The adverse skin effects experienced are summarized in [Table 2].
Table 2: Adverse skin effects experienced due to mask usage

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To get relief from the aforementioned symptoms while majority of the participants (41.2%) did not do anything, 25.5% moisturized skin using hand cream, body lotion, etc., after using sanitizer.

Out of the total respondents, 92% used latex gloves. About 40.6% of the participants used them for an average duration of less than 1 h. The adverse effects experienced by the participants are shown in [Table 3].
Table 3: Adverse skin effects experienced due to glove usage

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About 72.1% of the participants did not have a history of latex allergy, whereas 22.4% had no knowledge of the same. The adverse effects began to manifest mostly less than 1 h into using gloves (15.2%) or 1–3 h into using gloves (14.5%); 50.7% of the participants did not do anything to get relief from the adverse effects and out of the ones who did, 20.8% used moisturizers.

There was no statistically significant difference in the adverse effects of masks, gloves, and sanitizers between males and females, nor was it different for different age groups.


  Discussion Top


The side effect profile of masks, like acne and rash, was lesser compared with a previous study by Purushothaman et al.[5] Acne and rash were experienced by 30.3% and 25.5%, respectively, in our study vs. 56% and 39% in the aforementioned study [Table 4]. Also itching around the cheek which was the commonest side effect in our study was not reported in the study of Yuan et al.[6] [Table 5]. This difference in the prevalence may be due to the difference in humidity and temperature in different geographical areas of the country. The type of skin which may vary according to ethnicity may also have contributed to the difference in incidence of side effects with usage of masks in different areas of the country. The prevalence of headache is comparable to the study by Lim et al.[7] showing 35.2% in our study vs. 37.3% in theirs, which may reflect the similarity in frequency and duration of usage of masks [Table 6]. However, dizziness was much less (7.3%) compared to the study by Yuan et al. with 52.8%. Breathlessness was reported in a significant percentage of HCWs (42.4%), even though it was lesser compared to the 59.3% incidence reported in the study of Yuan et al. [Table 5].
Table 4: Comparison of the current study with a previous study conducted by Purushothaman et al.[5]

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Table 5: Comparison of the current study with a previous study conducted by Yuan et al.[6]

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Table 6: Comparison of the current study with a previous study conducted by Lim et al.[7]

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Masks were previously used while doing procedures like surgery when people usually do not have to talk continuously but in the present scenario routine activities such as talking with patients, examining them, and doing ward rounds are all being done while wearing mask which may lead to hypoxia and increase in the work of breathing. This remains a speculative explanation and needs further studies to confirm the same.

Frequent sanitizer use led to dryness of the skin in almost half of the participants. Currently, there is no adequate information about the prevalence of dryness due to sanitizer use.

The routine use of gloves led to dryness in around a third of the HCWs which was lesser than that reported in the study by Kaihui et al.,[1] in which it was present in almost half of the participants. The difference in the type of gloves (plastic/latex/rubber) may have contributed to this difference.

The strength of the study is that this is an adequately powered study with reasonable number of participants and to the best of our knowledge the first one of its kind from the state of Kerala. However, this study has a few limitations. The main drawback was that it was a questionnaire-based study which the participants filled online and hence the credibility of the answers was not ascertained. The stress of dealing with extra duties and the fear of contracting COVID could have contributed to a few symptoms and were not factored in. Additionally, the study was conducted in a tertiary care setup, and the results may not be applicable in a primary care setup.

In conclusion, the use of face masks, gloves, and sanitizer is imperative to limit the spread of disease, but prolonged use can cause discomfort that might hinder normal performance. Some individuals may also become averse to taking these essential preventive measures, thus setting a dangerous precedent. Curative strategies may be employed and alternatives may be looked into.

Acknowledgments

The authors thank Col. Vishal Marwaha for taking the initiative to create groups of MBBS students for conducting research related to COVID-19, questionnaire distribution, and questionnaire review. They thank Jayalekshmi S. Pillai for her support and guidance and help with questionnaire distribution and Col. Vishal Marwaha, Dr. Girish, Dr. Saraswathy, Dr. Nisha Bhavani, and Dr. Remya for questionnaire review. The authors also thank Juilee Bhale, student of Hinduja College of Commerce, and Minu for help with sample size.

Author contributions

AA, AA, MP, KNN, NS: concept, design, definition of intellectual content, literature search, data acquisition, manuscript preparation.

Dr NB: concept, definition of intellectual content, manuscript preparation, editing, and review.

ASN: data analysis.

The manuscript has been read and approved by all the authors, and each author believes that the manuscript represents honest work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kaihui H, Jing F, Xueqin L, Xin G, Xinyuan L, Xiang Z. The adverse skin reactions of health care workers using personal protective equipment for COVID-19. Medicine2020;99. Available from: https://pubmed.ncbi.nlm.nih.gov/32541493/.  Back to cited text no. 1
    
2.
Newsroom [Internet] (cited November 30, 2020). Available from: http://www.who.int/news-room.  Back to cited text no. 2
    
3.
Golin AP, Choi D, Ghahary A. Hand sanitizers: A review of ingredients, mechanisms of action, modes of delivery, and efficacy against coronaviruses. Am J Infect Control 2020;48: 1062-7.  Back to cited text no. 3
    
4.
Rosner E. Adverse effects of prolonged mask use among healthcare professionals during COVID-19. J Infect Dis Epidemiol 2020;6:130. Available from: https://clinmedjournals.org/articles/jide/journal-of-infectious-diseases-and-epidemiology-jide-6–130.php?jid=jide.  Back to cited text no. 4
    
5.
Purushothaman PK, Priyangha E, Vaidhyswaran R. Effects of prolonged use of facemask on healthcare workers in tertiary care hospital during COVID-19 pandemic. Indian J Otolaryngol Head Neck Surg 2020;73:1-7. Available from: https://pubmed.ncbi.nlm.nih.gov/32953633/.  Back to cited text no. 5
    
6.
Yuan N, Yang WX, Lu JL, Lv ZH. Investigation of adverse reactions in healthcare personnel working in level 3 barrier protection PPE to treat COVID-19. Postgrad Med J 2021;97:351-4.  Back to cited text no. 6
    
7.
Lim EC, Seet RC, Lee KH, Wilder-Smith EP, Chuah BY, Ong BK. Headaches and the N95 face-mask amongst healthcare providers. Acta Neurol Scand 2006;113:199-202.  Back to cited text no. 7
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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