Impact of Personal Cooling on Performance, Comfort and Heat Strain of Healthcare Workers in PPE, a Study From West Africa

Ana Bonell, Behzad Nadjm, Tida Samateh, Jainaba Badjie, Robyn Perry-Thomas, Karen Forrest, Andrew Prentice, Neil Maxwell

Research output: Contribution to journalArticlepeer-review


Background: Personal protective equipment (PPE) is an essential component of safely treating suspected or confirmed SARS-CoV-2 patients. PPE acts as a barrier to heat loss, therefore increasing the risk of thermal strain which may impact on cognitive function. Healthcare workers (HCWs) need to be able to prioritize and execute complex tasks effectively to ensure patient safety. This study evaluated pre-cooling and per-cooling methods on thermal strain, thermal comfort and cognitive function during simulated emergency management of an acutely unwell patient. Methods: This randomized controlled crossover trial was run at the Clinical Services Department of the Medical Research Unit The Gambia. Each participant attended two sessions (Cool and Control) in standard PPE. Cool involved pre-cooling with an ice slurry ingestion and per-cooling by wearing an ice-vest external to PPE. Results: Twelve participants completed both sessions. There was a significant increase in tympanic temperature in Control sessions at both 1 and 2 h in PPE (p = 0.01). No significant increase was seen during Cool. Effect estimate of Cool was −0.2°C (95% CI −0.43; 0.01, p = 0.06) post 1 h and −0.28°C (95% CI −0.57; 0.02, p = 0.06) post 2 h on tympanic temperature. Cool improved thermal comfort (p < 0.001), thermal sensation (p < 0.001), and thirst (p = 0.04). No difference on cognitive function was demonstrated using multilevel modeling. Discussion: Thermal strain in HCWs wearing PPE can be safely reduced using pre- and per-cooling methods external to PPE.

Original languageEnglish
Article number712481
JournalFrontiers in Public Health
Publication statusPublished - 1 Sept 2021

Bibliographical note

© 2021 Bonell, Nadjm, Samateh, Badjie, Perry-Thomas, Forrest, Prentice and Maxwell. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Funding Information:
We would like to thank all CSD staff who participated in the study with such willingness and enthusiasm and wore PPE on days when they could have had a rest from it. Funding. AB was funded by a Wellcome Trust Global Health PhD Fellowship (203905). BN was funded through the PaTS trial (UKRI COVID19 strategic priorities Supplementary funding for MRC Unit The Gambia at the LSHTM Grant reference: MC_PC_19084 Grant Recipient Anna Roca). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.


  • cognitive function
  • cooling
  • healthcare workers
  • heat strain
  • occupational heat strain
  • personal protective equipment


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