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Gastrointestinal symptoms associated with PPE use among nurses in COVID-19 wards: a cross-sectional study
Wenyu Li1, Xutao Wu1, Yani Yan1
1Emergency Department, Longgang Branch, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Objective:
To investigate the prevalence of gastrointestinal symptoms (reflux, nausea, and vomiting) among nurses in COVID-19 isolation wards and identify associated factors, with a specific focus on discomfort caused by personal protective equipment (PPE).
Study Design:
A cross-sectional survey.
Methods:
In March 2020, 354 of 368 eligible nurses (96.2% response rate) from the COVID-19 isolation wards of a designated hospital in Wenzhou, China, completed the survey. Data were collected using a demographic questionnaire, a self-rated PPE discomfort scale, the Gastroesophageal Reflux Disease Questionnaire (GerdQ), the Pittsburgh Sleep Quality Index (PSQI), and the Symptom Checklist-90 (SCL-90). Statistical assessments included univariate, correlation, and multivariable logistic regression analyses. Firth's penalized likelihood logistic regression and sensitivity analyses were applied to address sparse data in specific subgroups.
Results:
The overall prevalence of gastrointestinal symptoms in the cohort was 23.2% (82/354). Multivariable regression identified several independent factors significantly associated with these symptoms (all P < 0.01): severe PPE-induced discomfort (OR = 3.64, 95% CI: 1.95-6.80), elevated psychological stress (SCL-90 total score: OR = 1.14, 95% CI: 1.09-1.20), and poor sleep quality (PSQI total score: OR = 2.10, 95% CI: 1.51-2.92). Although univariate analyses suggested protective associations for prior intensive care unit (ICU) experience and male gender, these effects lost statistical significance following Firth correction. Temporally, 76.8% of symptomatic cases emerged within the first five days of the shift cycle.
Conclusions:
Gastrointestinal symptoms are prevalent among nurses in COVID-19 isolation wards and are strongly associated with PPE-induced discomfort, psychological stress, and sleep disturbances. Although the cross-sectional design precludes causal inference, these findings underscore an urgent need for the ergonomic optimization of PPE to alleviate heat stress and physical burden. Furthermore, implementing rapid adaptation training programs and integrating psychological and sleep support into routine occupational health surveillance are vital to safeguarding frontline clinicians.
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