Acute stress reaction related to use of personal protective equipment in health-care workers

Sir,

Use of personal protective equipment (PPE) for the first time can be a very suffocating experience, to the extent that it can lead to panic attacks and make the health-care workers (HCWs) dysfunctional. In this report, we present the description of a 40-year-old HCW, who developed a fear of donning PPE, leading to significant dysfunction.

A 40-year-old nurse presented to emergency services with severe anxiety. She was trained in donning and doffing and did not experience any difficulty at the time of training. On the 1^st day of her duty, within minutes of donning her suit, she became uncomfortable, and she experienced a panic attack. She immediately removed her PPE and while doing so was gasping for air. She returned to her usual self in the next half an hour but was not able to do the duty further on that day. On that night, she had difficulty in sleeping and remained preoccupied with the thought of wearing the PPE and was afraid that she may not be able to breathe. She went to work on the subsequent days, was able to don the hazmat suit, but avoided the face shield. Throughout the duty hours, she experienced discomfort and just kept on thinking about when her duty is going to end. After two more days of experiencing similar symptoms, she proceeded on leave. While on leave, she continued to have anxiety when left alone, in dark and closed places. Additionally, she had sleep disturbance, apprehension of going back to COVID-19 ward again. After 4–5 days of leave, she came to know that she was again posted in COVID intensive care unit; this led to significant worsening of symptoms and emergency visit. There was no history of any depressive symptoms, while being evaluated in the emergency. On mental status examination, she was found to be anxious and stated that, although she was scared of contracting the virus to some extent, but her primary concern was the distress associated with wearing the PPE. Based on the available information, a diagnosis of Acute Stress Reaction (as per the International classification of diseases, tenth revision) was considered. She was advised clonazepam and taught relaxation exercise with which she perceived some improvement.

During the ongoing COVID-19 pandemic, HCWs can have anxiety related to fear of contracting the infection, spreading the infection to their family members and others in the vicinity, stigma, fear of death, long duty hours, encountering frequent deaths while on duties, staying away from family members, staying in quarantine, and interpersonal issues at the workplace, etc.[1,2,3] However, in the wake of these anxiety provoking situations, wearing the PPE for long hours, can be another source of an anxiety, as was seen in the index HCW. Accordingly during training for donning and doffing, the HCWs should be prepared about the duration for which they have to be in the PPE, with and without face shields. The training should also incorporate relaxation techniques, so that in the time of crisis, the HCWs can practice the same, to keep themselves calm and safe.

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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.